Drugs for Inflammatory bowel disease (IBD)

• IBD is a chronic relapsing inflammatory disease of ileum & colon.
• Two major types are – ulcerative colitis(UC) & Crohn’s disease(CrD).

The drugs used in both these conditions are same, but their roles & efficacy differ.

The drugs are –
1. 5- amino salicylic acid compounds (5-ASA).
2. Corticosteroids.
3. Immunosuppressants.
4. TNF -alpha inhibitors.

1. 5- ASA compounds :-
  • Sulfasalazine :

– It is a sulfapyridine linked to 5-aminosalicylic acid by azo bond.
– The azo bond is split by colonic bacteria to release 5-ASA & sulfapyridine.
– 5-ASA is a local anti-inflammatory, by inhibiting COX & LOX – decreasing PG & LT secretion.
Migration of inflammatory cells into bowel is interfered, & mucosal secretion is reduced – symptomatic relief.
– The sulfapyridine moiety just carries 5-ASA to the colon , without itself being absorbed.
– Some sulfapyridine released is absorbed and produces ADRs like – rashes, fever, joint pain, blood dyscrasias.
Oligozoospermia & male infertility is reported.
Sulfasalazine interfere with folate absorption – folic acid supplementation is given.

Other drugs in this class include-

  • Mesalazine
    – 5-ASA is the active moiety in UC, but is not effective orally because of its inability to reach large bowel.
    – So it is formulated as a delayed release preparation coated with acrylic polymer.
  •  Olsalazine
  •  Balsalazide
2. Corticosteroids :

Prednisolone or any other equivalent drug is effective.
– Used for controlling symptoms as well as for inducing remission in both ulcerative colitis & crohn’s disease.
– Generally used for short term, discontinued after remission is induced.

3. Immunosuppressants :

– Used for long term treatment.
– They have long latency of response.
Azothioprine – a purine antimetabolite.
Methotrexate – dihydrofolate reductase inhibitor.

4. TNF alpha inhibitors :

Infliximab
– It is a anti – TNF alpha antibody
– Used when other drugs are not effective
Adalimumab is also a TNF alpha inhibitor used for IBD.


-Soumya Khot

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