1. IBD Treatment: The Basics
Megan Chan, PGY2
UHCMC

2. 5-ASA (Amino salicylic acid)
Uses:
Induction/Maintenance of UC
Very mild CD
Formulations:
Sulfasalazine = 5ASA + Sulfa
Mesalamine = 5ASA in pH sensitive or time-dependent capsules
Pentasa—time released duodenum to colon
Asacol—pH released in TI & colon
Lialda—pH released in TI & colon
Canasa = suppository (effective to cm)
Rowasa = enema (effective to splenic flexure)

3. Steriods Uses: Induction of UC & Crohn’s Topical: IV: PO:
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

4. Biologics (Anti-TNF) Infliximab (Remicade)—Crohn’s & UC
Adalimumab (Humira)--Crohn’s & UC
Certolizumab (Cimzia)—Crohn’s
Golimumab (Simponi)—UC

5. Immunomodulators Azathioprine (Imuran) 6MP (Purinethol)
Methotrexate (MTX)
Cyclosporine (Neoral)
*In combination with biologics, these can decrease Ab formation

6. Leukocyte Trafficking Agents
Natalizumab (Tysabri)—Crohn’s
Vedolizumab (Entyvio)—UC > Crohn’s

7. Antibiotics Useful in perianal and fistulizing Crohn’s
Flagyl mg/day
Cipro 1000mg/day

8. http://img. medscape. com/fullsize/migrated/584/835/apt584835. fig1