Inflammatory bowel disease (IBD) is a complex, lifelong condition that includes Crohn’s disease and ulcerative colitis. One of the most common questions patients ask me is, “Which medication is right for me?” The answer is rarely simple. There’s no one-size-fits-all approach because each person’s treatment plan depends on several unique factors.
The great news is that today, there are more effective and diverse treatment options for IBD than ever before, thanks to recent advances in medications and therapies. With so many choices available, it’s understandable that the process can feel overwhelming.
There’s no one-size-fits-all approach because each person’s treatment plan depends on several unique factors.
— Alan Moss, MD, chief scientific officer at the Crohn’s & Colitis Foundation
The best medication for you will depend on your specific diagnosis, the severity and activity of your disease, your previous experiences with treatments, your age and life stage, and your personal preferences. By understanding what factors matter most, you can work with your healthcare team to find a plan that fits your needs and lifestyle.
To help patients and caregivers make informed decisions, the Crohn’s & Colitis Foundation offers an easy-to-use IBD Medication Guide, which provides up-to-date information on all treatments that are approved by the U.S. Food and Drug Administration (FDA).
Here are five important considerations to discuss with your doctor when choosing an IBD medication.
1. Disease Location: Crohn’s Disease vs. Ulcerative Colitis
Your specific diagnosis — Crohn’s disease or ulcerative colitis — guides many treatment decisions. These two forms of IBD affect different parts of the digestive tract and may respond differently to certain medications.
For example, a group of IBD medications called aminosalicylates (5-ASA drugs) are effective for mild to moderate ulcerative colitis but are less helpful for Crohn’s disease, especially when the small intestine is involved. Different types of medications called immunomodulators, biologics, and small molecule therapies are FDA-approved for Crohn’s disease, ulcerative colitis, or both.
The location of your disease influences which treatment is right for you; for example, vedolizumab (Entyvio) targets only the intestinal tract, whereas ustekinumab (Stelara) targets both the intestinal tract and other inflamed organs, such as skin or joints.
2. Disease Activity
How severe your IBD is at the time you’re evaluated is a key factor in treatment choice. Disease activity refers to your current symptoms and test results, such as blood work, stool markers like fecal calprotectin (a protein released by inflammatory cells in the digestive tract), and endoscopy findings. Active disease can be mild, moderate, or severe; more severe disease increases the risk of complications or the need for hospitalization.
For mild disease, your doctor may recommend medications like 5-ASAs or steroids (temporarily) and select formulations that act primarily in the colon. For moderate to severe disease, more systemic therapies, such as immunomodulators, biologics, or small molecule inhibitors, are often needed to dampen the inflammation. If you have a severe flare, treatment may need to start quickly, sometimes with intravenous medications or steroids to control inflammation and prevent complications.
Your doctor will consider how often you’ve had flare-ups and hospital stays or needed steroids in the past to help choose the best medication for you.
3. Previous Medication Exposure and Treatment Response
Your past experiences with IBD medications — what you’ve tried, what worked, and what didn’t — are critical in shaping your current treatment plan. If you have previously used certain advanced therapies (like antitumor necrosis factor [TNF] biologics) and they stopped working for you or caused side effects, your doctor may recommend switching to a medication with a different way of working, such as an interleukin (IL)-12/23 inhibitor or a Janus kinase (JAK) inhibitor.
The first biologic you use often has the highest chance of long-term effectiveness, so making an informed choice early on is valuable.
If you are stable and in remission, there is usually no need to switch medications unless you develop side effects or it stops working for you. Stopping an effective medication is generally discouraged; about half of patients who discontinue therapy will experience a return of their symptoms.
4. Special Scenarios: Age, Pregnancy, and Extraintestinal Symptoms
Certain life stages and health situations can affect which medications are safest and most effective.
For children and teens, not all medications are approved or available. Growth and bone health are especially important to consider because IBD can interfere with them. If not addressed, these issues can result in reduced final height as an adult and long-term bone health problems. Pediatric IBD often involves more extensive disease and may require early use of advanced therapies to support growth and development.
For older adults, the safety of each medication is carefully considered. Some biologics, such as anti-integrin or IL-12/23 inhibitors, are often favored for their lower risk of systemic (whole-body) side effects. If you are pregnant or planning pregnancy, most biologics are considered safe and are continued during pregnancy, but JAK inhibitors should be avoided.
Some people with IBD also experience symptoms outside the gut, such as joint pain or skin rashes. In these cases, medications that target inflammation both inside and outside the intestines — like anti-TNF drugs or certain small molecule inhibitors — may be preferred.
5. Lifestyle, Preferences, and Shared Decision-Making
Your personal preferences and lifestyle should play a major role in choosing the right IBD medication. Considerations include:
- How the medication is taken (oral pill, self-injection, or intravenous [IV] infusion in a clinic)
- How often you need to take or receive the medication (daily, weekly, or every eight weeks)
- Your comfort with needles or infusions
- The impact of the medication on your daily life, work, or school schedule
- Insurance coverage and cost (sometimes your plan will dictate which medications are and are not covered)
Shared decision-making is essential. You and your healthcare team should work together to weigh the benefits and risks of each option, taking into account your goals, values, and concerns. Open communication and regular follow-up are key to finding the best treatment for you and adjusting it as your needs change.
By working closely with your healthcare team and staying informed, you can find a treatment plan that helps you achieve remission and maintain a good quality of life.
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