Transcript IBD Treatment Basics

IBD Treatment:
The Basics
Megan Chan, PGY2
UHCMC
5-ASA (Amino salicylic acid)
• Uses:
– Induction/Maintenance of UC
– Very mild CD
• Formulations:
– Sulfasalazine = 5ASA + Sulfa
– Mesalamine = 5ASA in pH sensitive or timedependent capsules
• Pentasa—time released duodenum to colon
• Asacol—pH released in TI & colon
• Lialda—pH released in TI & colon
– Canasa = suppository (effective to 10-15 cm)
– Rowasa = enema (effective to splenic flexure)
Steriods
• Uses: Induction of UC & Crohn’s
– NOT for maintenance, fistulizing/stricturing Crohn’s
• Topical:
– Cortifoam/Cortenema—best for proctitis &
proctosigmoiditis
– Budesondie (Entocort)—oral  pH released in TI &
right colon
• IV:
– Solumedrol 20mg q8hrs
– Hydrocortisone 100mg q8hrs
• PO:
– Prednisone 40-60mg with taper over 1-2 months
Biologics (Anti-TNF)
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Infliximab (Remicade)—Crohn’s & UC
Adalimumab (Humira)--Crohn’s & UC
Certolizumab (Cimzia)—Crohn’s
Golimumab (Simponi)—UC
Immunomodulators
• Azathioprine (Imuran)
• 6MP (Purinethol)
• Methotrexate (MTX)
• Cyclosporine (Neoral)
*In combination with biologics, these can
decrease Ab formation
Leukocyte Trafficking Agents
• Natalizumab (Tysabri)—Crohn’s
• Vedolizumab (Entyvio)—UC > Crohn’s
Antibiotics
• Useful in perianal and fistulizing Crohn’s
• Flagyl 750-1000mg/day
• Cipro 1000mg/day
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