Following your investigations, when a diagnosis has been reached, your doctor will decide how best to treat your IBD. Things such as the severity and location of disease will be considered prior to choosing a treatment. Your doctor will also take into consideration how you are coping with your symptoms.
It is important to remember that IBD affects everybody differently and your doctor may have to try a number of treatments before finding what works for you.
Medications used in IBD
Steroids, oral (prednisolone) or injected (hydrocortisone) may be used to treat acute attacks. Steroids are not a long term treatment for IBD. They are usually given over 8 weeks and the dose is reduced gradually until the course is finished. It is important to finish the course as instructed by your doctor and not to stop taking steroids abruptly. This is to allow your body to start making its own natural steroids.
It is important to take a calcium supplement, when taking steroids as your bones can be weakened by steroid use.
Steroids can be very effective for your bowel symptoms but can cause side effects such as water retention, muscle weakness, eye and skin changes and mood swings. They may also cause high blood pressure, stomach ulcers, osteoporosis (weakening of the bones), and high blood sugar. If you are worried about any side affects you may be experiencing, you should contact your doctor or IBD Nurse who will be able to advise you.
This group of medications include mesalazine (Asacolon, Pentasa, Salotalk, Mezavant), and sulphasalazine (Salazopyrin).
They are also called 5-ASA medications. Your doctor will choose the medication most suitable for your disease. These medications reduce the inflammation in the colon and help to heal the inflamed intestine lining. They are useful in treating mild to moderate flare-ups and are used to keep your disease in remission.
Azathioprine and 6-Mercaptopurine
These medications are often used if you need repeated courses of steroids or if your symptoms return when you reduce your dose of steroids. They may also be prescribed if you have had surgery for Crohn's disease or if you have Crohn's disease in more than one area of your gastrointestinal tract. They are also used to work with other treatments to increase medication levels in your system.
You may also hear your doctor refer to these drugs as steroid sparing drugs, immunosuppressants or immunomodulators.
Immunomodulators can take up to four months to become fully effective and for this reason you may be prescribed them in conjunction with a course of steroids or sometimes even when you are feeling quite well as there is evidence that these medications are useful in preventing a recurrence or flare of your disease.
They are associated with side effects such as allergic reactions, inflammation of the pancreas gland (pancreatitis), liver problems and a reduction in the white cells in the blood which can increase your risk of infection. When you are on immunomodulators, you will need to have blood tests done regularly.
Your doctor or IBD Nurse will give you written information prior to starting these medications and discuss the timing of blood testing.
Methotrexate is another immunomodulator, sometimes given to patients not responding to, or intolerant of azathioprine or 6-mercaptopurine. It is given as an injection and sometimes in tablet form once weekly (preferably on the same day).
As with all immunomodulators it can lead to the development of infections, it can also cause problems with white blood cells which may increase your risk of infection. Rarer side effects include lung and liver damage.
Nausea and vomiting are the most common side effects of this drug, if you are suffering from nausea and vomiting, let your doctor know and they will be able to prescribe anti-nausea medication for you.
As methotrexate can reduce folic acid, which is needed for actively growing cells, it is necessary to take folic acid supplements/tablets.
Methotrexate should not be taken if you are pregnant or plan to become pregnant. It is important to use a reliable form of contraceptive while on methotrexate and for three months after stopping it, as methotrexate has been linked to serious birth defects and pregnancy complications.
Ciclosporin is an immunosuppressant drug which is given intravenously to patients with severe Ulcerative Colitis, who are not responding to intravenous steroids. This drug may be suggested if you have had TB or cancer in the past.
People on this drug are at increased risk of developing infections. It is also associated with high blood pressure and change to kidney function. You will need to have blood tests to monitor drug levels closely.
IF YOU HAVE BEEN PRESCRIBED DRUGS THAT CAUSE IMMUNOSUPPRESSION YOU SHOULD HAVE THE YEARLY SEASONAL FLU VACCINE AND THE PNEUMOCOCCAL VACCINE
Biologic drugs are made from proteins. Biosimilar medications are a newer version of original biological drugs and work in the same way.
Before starting biologic drugs, your doctor will organise for you to have a chest X-ray, and test for tuberculosis (TB). You will also need to have some blood tests to check if you have been exposed to certain viruses.
The side effects of these drugs include allergic reactions, infections and are similar to those experienced with immunomodulators. Some people are at increased risk of developing heart problems on biologics, because of this you should always tell your doctor if you have had heart problems (regardless of your age), and they will arrange for any tests that may be necessary prior to starting the drug. Biologics can also increase your risk of certain cancers such as skin cancer and lymphoma.
Infliximab is given as an infusion via a drip at week 0, 2 and 6, (induction). If your symptoms respond you will continue this medication. The timing and dosing of Infliximab will be decided by your doctor and depends on a number of factors such as the level of drug in your system and how your symptoms respond. This can change over time. You will have blood tests on each visit to the hospital and you will be asked if you have any infection or are on antibiotics. Infliximab can also be used, if you are having a severe flare of your ulcerative colitis which is not responding to intravenous steroids.
Adalimumab is given as an injection every two weeks. You will be taught how to give yourself the injection at home. The dose and frequency may be changed under the guidance of your doctor.
Golimumab is given as an injection every two weeks for the first month and every four weeks after that. You will be taught how to give yourself the injection at home.
Ustekinumab is given as an infusion/drip and then followed by 8 weekly injections which you will be taught to give at home.
You should never give yourself your biologic injection if you have an infection or are on antibiotics without consulting your doctor or IBD Nurse.
Vedolizumab is given as an infusion via a drip in the hospital at week 0, 2 and 6, (induction). If your symptoms respond you will continue on this medication. The timing and dosing will be decided by your doctor and will depend on how your symptoms respond to the medication.
If you are on immunomodulators when starting biologics, your doctor will discuss with you whether you should continue them.
It is important to attend your doctor regularly and have regular blood tests while on biologics.
Tofacitinib is a treatment for active colitis. You may be prescribed Tofacitinib tablets if you have had an inadequate response, lost response, or were intolerant of other treatments. At high doses this drug can increase your risk of developing a blood clot. Your doctor will prescribe an injection to prevent clots.
IF YOU HAVE BEEN PRESCRIBED DRUGS THAT CAUSE IMMUNOSUPPRESSION, YOU SHOULD USE SUNSCREEN AND AVOID LONG PERIODS IN THE SUN
Antibiotics may be used for acute attacks of Crohn's disease, particularly if the anus is affected (perianal disease).
You may be asked if you are interested in taking part in a clinical trial for new drugs for IBD. The goal of clinical trials is to determine if a new treatment works and is safe. Clinical trials can provide access to the newest treatments for IBD. If you are interested in clinical trials your doctor or IBD Nurse will be able to advise you if there is a suitable clinical trial available for you and refer you to the Clinical Trials Co-ordinator.
It is important to take your medication as prescribed by your doctor. It is also important to stay on your medication, even when you are well as the aim of treatment of IBD is to keep the disease in remission and prevent flare ups.
There may be many changes in your medication regime during the course of your IBD and this can be confusing at times. If you are ever unsure or confused about medication changes or combinations, you should contact your doctor or IBD Nurse, who will be able to guide you.