Newer Medications for Inflammatory Bowel Disease Treatment: Are they appropriate for you?

Todd Eisner Health Guide
  • I have to take many pills each day. I have heard that there is an extended release version that I may be able to take instead. Is this true?


    Asacol is composed of mesalamine, an anti-inflammatory specific for the gastrointestinal tract. It is also the major component of other medications used to treat ulcerative colitis and Crohn's disease, Pentasa, all 9 brand names. Rowasa enema and Canasa suppositories. Lialda is a recently approved mesalamine product that has two advantages over Asacol and Pentasa. First of all, while Asacol comes in a 400 mg tablet, Lialda contains three times the amount of mesalamine, or 1.2 grams. Secondly, Lialda is an extended release tablet that is taken once a day, in the morning. A major problem in the treatment of inflammatory bowel disease is compliance to medication. While the starting dose of Asacol in patients with active ulcerative colitis is typically 800 mg three times a day (six pills for a total of 2.4 grams), and can go as high as 1.6 grams four times a day (sixteen pills for a total of 6.4 grams),  patients taking Lialda can take two to four pills once a day in the morning with similar results. As compliance is better, efficacy tends to be even better. You should check with your physician to see if Lialda is a treatment option for you.

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    I have intermittently been on the steroid Prednisone for my Crohn's disease. A friend of mine is taking Entocort. Is it better than Prednisone?


    Studies have shown that Entocort can provide symptom control for Crohn's disease flares comparable to prednisone and effective maintenance therapy for many people with mild to moderate Crohn's disease. Although Entocort is a steroid, it has a dramatically reduced frequency of steroid-related side effects than prednisone. While prednisone and other oral steroids have to circulate throughout your entire body to work, Entocort releases most of its medicine in the intestine. It works locally and is mostly absorbed there. As little as 10% of the drug circulates throughout the body. The most common side effects of Entocort are headache, respiratory infection, nausea, and an increase in the size of the face and neck, acne, and bruising. It does not cause any of the serious side effects of Prednisone. Most of the side effects above occur less often with Entocort than with Prednisone. You should check with your doctor to see if Entocort is an option for the treatment of your Crohn's disease.


    I have failed all treatment for my Crohn's disease including Remicade and Humira. Are there any newer agents available to treat Crohn's disease?


    Tysabri was approved for treatment of Crohn's disease in January of this year. It is a biologic agent that was approved for the treatment of Multiple Sclerosis in November 2004. It was taken off the market a short while later when it was associated to a rare brain disease known as progressive multifocal leukoencephalopathy. The three affected patients, two of whom died, had also been taking other medications that might have contributed to the disorder. After much investigation, the drug was reapproved by the FDA in June of 2006. Due to this potential complication, its use should be reserved for those patients who have had an inadequate response to, or are unable to tolerate, conventional Crohn's disease therapies. Crohn's disease patients using the drug must be enrolled in a special restricted distribution program called the Crohn's Disease-Tysabri Outreach Unified Commitment to Health (CD TOUCH) Prescribing Program. The drug is given intravenously at infusion centers, and should not be given if other immunosuppressive agents are used due to a potential increase in serious rare infections. Patients should be evaluated after three months of treatment to determine if they have improved on Tysabri. If not, patients should discontinue treatment. People who are taking steroids for Crohn's disease should begin tapering steroid doses while on Tysabri. Treatment should be discontinued if steroids cannot be fully tapered within six months. While it currently should only be considered as a "last resort" treatment option prior to surgery, you should check with your physician to see if it might be the right drug for you.

Published On: April 21, 2008