Anti-Inflammatory Drugs Are First-Line Treatments for IBDs

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) or disorder that can cause inflammation and further complications, such as ulcers in the digestive tract system.

UC affects the inside lining of the colon or large intestine, as well as the rectum.

Crohn disease (CD) is another type of IBD that causes inflammation in the digestive tract and other areas. This inflammation mostly spreads to deeper layers of the bowel system. Both CD and UD have no cure, though there are treatment options that can reduce the signs and symptoms of the disease. Both diseases can cause painful and possibly life-threatening symptoms that can affect the quality of life for patients.¹

UC symptoms may include abdominal pain, fatigue, fever, cramping, diarrhea, failure to grow in children, rectal bleeding and pain, and weight loss. Symptoms of CD can include abdominal pain, blood in the stool, cramping, diarrhea, drainage or pain around or near the anus, fatigue, fever, mouth sores, reduced appetite, and weight loss.¹

IBD affected an estimated 1.3% of US adults in 2015, according to CDC data.²

This accounts for 3 million individuals with either CD or UD. These findings demonstrate a large increase from the data in 1999, which showed just 2 million people affected.² Individuals affected at higher rates include patients aged 45 years or older, Hispanic and white individuals, those who are less educated, those who are not employed, and individuals born in the United States.

Both diseases have major hospitalizations and costs associated with them. In 2015, the hospitalization costs for CD were approximately $11,345 and were approximately $13,412 for UC.² Patients affected by CD or UC have higher chances of being diagnosed with other chronic health conditions as well, such as arthritis, cancer, and cardiovascular, kidney, liver, and respiratory diseases.

Patients of Medicare age with IBD were at higher risk of being hospitalized for hip fractures and had higher rates of 30-day readmissions as well as longer hospitalizations, according to CDC data.²

Anti-inflammatory drugs are usually the first step for UC treatment, including 5-aminosalicylates, such as balsalazide, mesalamine, and sulfasalazine. Corticosteroids, such as budesonide and prednisone, can also be used, for more moderate to severe UC. Corticosteroids are given on a short-term basis, because of the number of associated adverse effects.

Immunosuppressants can also be used for patients with UC, including azathioprine, cyclosporine, mercaptopurines. They also include tofacitinib, which can stop the process of inflammation. Biologics offer other options, including adalimumab, golimumab, or infliximab. These are called tumor necrosis factor (TNF) drugs. Another option is vedolizumab, which blocks the inflammatory cells from getting to the inflammation site. If none of those options are tolerated, ustekinumab can be used. Other medications may include anti-diarrheal medications and pain relievers to address adverse events and symptoms caused by the disease. Sometimes, patients may also need iron therapy because of continuous bleeding episodes.¹

When it comes to CD, just like UC, anti-inflammatory medications are 1 of the first steps for treating the disease. These may include corticosteroids, such as 5-aminosalicylates, and immunosuppressants, such as azathioprine and methotrexate. The disease is also treatable with biologics, such as adalimumab, certolizumab, natalizumab, tumor necrosis factor inhibitors, ustekinumab, and vedolizumab. Antibiotics can also be used to treat the drainage from abscesses and fistulas. These may include ciprofloxacin and metronidazole. Just like for UC, patients with CD can take anti-diarrheal supplements or pain relievers to address their symptoms.³

CD may require more frequent colonoscopies and upper endoscopies, whereas UC may require colonoscopies and sigmoidoscopies.⁴ Removal of the colon and rectum is considered a cure for UC.

With the treatment options available and increasing early diagnosis techniques, as well as medications on the horizon, patients suffering from CD and UC can benefit tremendously. When symptoms are controlled, these patients can have an improved quality of life free of pain.

References

1. Mayo Clinic. Ulcerative colitis: overview. February 23, 2021. Accessed June 30, 2021. https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/symptoms-causes/syc-20353326

2. CDC. Inflammatory bowel disease. Reviewed August 11, 2021. Accessed June 30, 2021. https://www.cdc.gov/ibd/data-statistics.htm

3. Mayo Clinic. Crohn’s disease: diagnosis. October 13, 2020. Accessed June 30, 2021. https://www.mayoclinic.org/diseases-conditions/crohns-disease/diagnosis-treatment/drc-20353309

4. Fletcher J. What is the difference between Crohn’s disease and ulcerative colitis? Medical News Today. June 6, 2017. Accessed June 30, 2021. https://www.medicalnewstoday.com/articles/317792