Inflammatory Bowel Disease (IBD)

Starting a new medicine

The goal of treatment for inflammatory bowel disease (IBD) is to help you feel your best and to help avoid complications. The first step in helping you feel your best is to work towards reducing your symptoms and the inflammation in your gastrointestinal tract. This is usually done with medicines.

Treating IBD with medicine happens in 2 phases: induction and maintenance.

• The initial phases of treating the inflammation associated with IBD with medicine is called the induction of therapy. The medicine prescribed to you during the induction phase is meant to help you get well. In the induction phase, your healthcare provider is trying to get your inflammation under control.
• After the induction phase, you will enter the maintenance of therapy phase. During the maintenance phase, your healthcare provider will use medicine to help keep you well. It is important that you do not stop taking any of your IBD medicines during the maintenance phase unless your healthcare provider tells you to, even if you feel well.

Types of IBD medicine

There are 5 main types of IBD medicine:

• 5-ASAs (also called 5-aminosalicylates or sulfasalazine). 5-ASAs target the lining of the gastrointestinal tract. They are primarily used to treat mild to moderate ulcerative colitis.
• Immunomodulators (also called immunosuppressants). Immunomodulators target the immune system. They are used to treat Crohn’s disease and ulcerative colitis. They can be used to treat active or inactive disease.
• Steroids (also called corticosteroids). Steroids target the immune system. They are used as a short-term treatment for moderate to severe active Crohn’s disease or ulcerative colitis. Long-term or repeated use of steroids should be avoided.
• Biologics (also called biotherapies, originator biologic, or biosimilars). Biologics target a specific part of the immune system. They are used to treat Crohn’s disease and ulcerative colitis. They can be used to treat active disease or maintain inactive disease.
• Small molecules (also called JAK inhibitors or S1P inhibitors). Small molecules target a specific part of the body’s immune cells. They are primarily used to treat ulcerative colitis, although some are used to treat Crohn’s disease.

Biologics

Biologics are made from living organisms. They are designed to target specific parts of the immune system that drive inflammation in IBD.

There are different types of biologics. The biologic you use depends on your specific IBD condition and severity, as well as how you responded to previous treatments.

Most biologics are started with a higher initial loading dose to quickly bring the IBD under control. After the loading phase, you’ll get a lower, regular maintenance dose to keep the disease in remission. How often you need this dose depends on the specific biologic.

For biologics to work as well as possible, it is important to follow your healthcare provider’s instructions about when to take your medicine and how to monitor your treatment. Ask your healthcare provider about the possible side effects of using biologics.

Before starting a new IBD medicine

Because many of the medicines used to treat IBD slow down your immune system, they can increase your risk of infections. To help lower this risk, before you start a new IBD medicine, visit your local public health centre or pharmacy to review your immunizations and make sure they are up to date. Once you have started immunosuppressive medicines you can no longer receive live vaccines, so it is important to have these updated before your treatment starts. Find a public health centre near you.

To further help lower your risk of infection, you will be asked to do tests to make sure you do not have chronic infections such as hepatitis B or tuberculosis. You may be asked to do a chest x-ray, blood tests, stool tests, and a tuberculin skin test (a test that checks to see if you have ever been exposed to tuberculosis).

Monitoring

During your treatment for IBD, you will be asked to do routine blood and stool tests to monitor how well the treatment is working and if you are having any side effects. Depending on the medicine you are using, you may need testing more often when your treatment first starts.

To see if you are healing, your healthcare provider may also use a bowel ultrasound, CT or MRI scan, or a colonoscopy, depending on what area of the gastrointestinal tract is affected by your IBD.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments and have your routine monitoring tests done. You can access your test results and track your symptoms using MyAHS Connect and review these with your healthcare provider at your next clinic visit.

For more information, see Inflammatory Bowel Disease: Information for Albertans.

To see this information online and learn more, visit MyHealth.Alberta.ca/health/aftercareinformation/pages/conditions.aspx?hwid=custom.ab_ibd_new_medicine_inst.

For 24/7 nurse advice and general health information call Health Link at 811.

Current as of: September 25, 2024

Author: Digestive SCN, Alberta Health Services

This material is not a substitute for the advice of a qualified health professional. This material is intended for general information only and is provided on an "as is", "where is" basis. Although reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for a particular purpose of such information. Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use.