From the Guidelines
The treatment for acute inflammatory bowel disease (IBD) should prioritize a step-up approach, starting with conventional immunosuppressive therapies such as azathioprine or 6-mercaptopurine, and progressing to biologics like infliximab or vedolizumab if necessary, as recommended by the WSES-AAST guidelines 1.
Overview of IBD Treatment
The management of IBD aims to achieve induction of remission, followed by maintenance therapy to prevent recurrent disease flares. Treatment regimens are tailored based on the type, distribution, and disease severity, as well as co-morbidity and patient preferences.
Initial Therapy
Initial therapy often includes corticosteroids like prednisone or budesonide to rapidly control inflammation. Aminosalicylates such as mesalamine may be used for mild to moderate ulcerative colitis.
Immunomodulators and Biologics
For moderate to severe cases, immunomodulators like azathioprine or 6-mercaptopurine may be added, though these take several weeks to become effective. Biologic agents like infliximab, adalimumab, or vedolizumab are often necessary for severe or refractory disease, as they have shown to be effective in reducing the risk of surgery and improving patient outcomes 1.
Supportive Care and Surgery
Supportive care includes intravenous fluids for dehydration, nutritional support, and pain management. Hospitalization may be required for severe flares, and surgery becomes necessary if medical therapy fails or complications like perforation, obstruction, or severe bleeding occur. The introduction of anti-TNF therapy and improved multidisciplinary IBD management have led to a decrease in the number of surgical cases performed in recent years 1.
Recent Guidelines and Recommendations
The WSES-AAST guidelines recommend a multidisciplinary approach to IBD management, emphasizing the importance of early recognition and treatment of complications, as well as the need for individualized treatment plans 1. By prioritizing a step-up approach and utilizing the latest therapeutic options, healthcare providers can improve patient outcomes and reduce the risk of morbidity and mortality associated with IBD.
From the FDA Drug Label
RENFLEXIS is a tumor necrosis factor (TNF) blocker indicated for: Crohn's Disease: • reducing signs and symptoms and inducing and maintaining clinical remission in adult patients with moderately to severely active disease who have had an inadequate response to conventional therapy. Ulcerative Colitis: • reducing signs and symptoms, inducing and maintaining clinical remission and mucosal healing, and eliminating corticosteroid use in adult patients with moderately to severely active disease who have had an inadequate response to conventional therapy.
The treatment for acute inflammatory bowel disease includes the use of infliximab (IV), a tumor necrosis factor (TNF) blocker, for:
- Crohn's Disease: reducing signs and symptoms and inducing and maintaining clinical remission in adult patients with moderately to severely active disease who have had an inadequate response to conventional therapy.
- Ulcerative Colitis: reducing signs and symptoms, inducing and maintaining clinical remission and mucosal healing, and eliminating corticosteroid use in adult patients with moderately to severely active disease who have had an inadequate response to conventional therapy 2.
From the Research
Treatment Options for Acute Inflammatory Bowel Disease
The treatment for acute inflammatory bowel disease (IBD) typically involves a combination of medications to reduce inflammation and manage symptoms. Some of the key treatment options include:
- Aminosalicylates, such as mesalamine, which have been shown to be effective in treating ulcerative colitis 3, 4
- Biologic agents, such as adalimumab, which may be used in combination with other medications for patients with moderate to severe ulcerative colitis 5
- Immunomodulators, such as azathioprine and 6-mercaptopurine, which may be used to maintain remission in patients with IBD 6
Mechanism of Action
The exact mechanism of action of these medications is not fully understood, but it is thought to involve:
- Reduction of inflammation and inhibition of immune responses 7
- Scavenging of free radicals and reduction of leukotriene production 7
- Inhibition of cellular release of interleukin-1 and other pro-inflammatory cytokines 7
Dosage and Administration
The dosage and administration of these medications can vary depending on the specific condition being treated and the severity of symptoms. For example:
- Mesalamine may be administered orally or rectally, with dosages ranging from 2.4 g/day to 4.8 g/day 3
- Adalimumab may be administered subcutaneously, with dosages and frequency of administration varying depending on the specific treatment regimen 5
- Azathioprine and 6-mercaptopurine may be administered orally, with dosages and frequency of administration varying depending on the specific treatment regimen 6
Efficacy and Safety
The efficacy and safety of these medications have been evaluated in numerous studies, with results indicating:
- Mesalamine is effective in treating ulcerative colitis, with response rates ranging from 40%-70% and remission rates ranging from 15%-20% 3
- Adalimumab may be effective in treating severe ulcerative colitis, with significant clinical improvement observed in some patients 5
- Azathioprine and 6-mercaptopurine are effective in maintaining remission in patients with IBD, but may have significant side effects, including myelosuppression 6