Early Oral & Topical Anti-inflammatory Therapies for IBD
This tool is a collection of oral and topical therapies used early in the treatment of inflammatory bowel disease (IBD). These early therapies include 5-ASA and corticosteroids. The tool is designed to assist IBD nurses and health care providers in educating patients when discussing treatment options for patients with IBD.
Ulcerative colitis is subdivided into three categories based on which part of the bowel is affected:
5-Aminosalicylates (5-ASA)
Sulfasalazine, Pentasa, Salofalk, Mezavant, Mezera, Octasa
Steroids
5-ASAs work locally in the bowel to help control inflammation without suppressing the entire immune system. They allow the damaged gut tissue to heal. These drugs act as anti-inflammatory agents to reduce the severity of bowel symptoms in mild-to-moderate ulcerative colitis.
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5-ASAs have been reported to be generally more useful for treating colitis than for treating Crohn’s disease. It remains uncertain how effective they are at treating Crohn’s disease. They are considered to be topical, that is, applied directly to the mucous membrane (inner lining) of the large intestine, because they coat the colon. This is why they are more useful for treating colitis – which is known to affect the inner lining of the colon – rather than for treating Crohn’s disease.
5-ASAs are considered first-line medications in the treatment of colitis.
Corticosteroids, or steroids, are hormones produced naturally in the adrenal glands located above your kidneys. Steroid medications used in the treatment of inflammatory bowel disease (IBD) are analogues of these hormones, but they are made synthetically.
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Steroids inhibit the immune system. In the gastrointestinal system, they stop the movement of inflammatory cells to the intestine, and they decrease the expression of inflammatory chemicals called cytokines. They cause activated white blood cells to die, and this reduces inflammation in the body.
Corticosteroids have dramatic effects on IBD. They act as a broad way of reducing inflammation but they are associated with significant long-term toxicity. Steroid medications in IBD are intended to be short-term treatment options for cases of moderate to severe Crohn’s disease and ulcerative colitis.
Health care providers try their best to avoid extended and repeated treatment with steroids because of the side effects. Corticosteroids are not to be considered for maintenance therapy.
