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HIBD Horizon

Part 2 · Getting treatment today · 5/22

The treatment staircase

The main families of treatment available today for Crohn's and UC, from the gentlest to the most targeted.

A change of strategy

BEFOREStep by step

You started gently, and only stepped up if it wasn't enough.

TODAY, IN CROHN'SHit hard from the start

In many patients, a biologic is started early, sometimes with an immunosuppressant.

AND IN UC?It depends

Mild UC is often treated well with mesalazine. If it is moderate to severe, advanced treatments are brought in quickly.

Why?

Crohn's can damage the bowel little by little, even when you feel well: strictures, fistulas, operations.
Treatments work better early in the disease, before the damage sets in.
The PROFILE trial (2024): 79% lasting remission when treating hard from the outset, versus 15% when stepping up gradually, and far fewer emergency operations.

The goalRemission without cortisone, with a healed bowel.

Nothing works?You change route: there is often another option.

The right treatmentIt is chosen with your gastro, according to your disease and your life.

Gut anti-inflammatories

5-ASA (mesalazine)

They act directly on the bowel wall. They are not NSAIDs like ibuprofen.

Pentasa, Fivasa, RowasaSalazopyrine

Who for : Mainly mild to moderate UC, as long-term treatment. Not very effective in Crohn's.

How : Tablets, granules, suppositories, enemas

Cortisone

steroids (corticosteroids)

It quickly puts out a flare, but does not stop it coming back.

PrednisoneCortancylPrednisoloneSolupredBudesonideEntocort, Mikicort (Crohn's); Cortiment (UC)

Who for : Crohn's and UC, for a few weeks only. Never as long-term treatment: bones, weight, sugar, eyes, mood.

How : Tablets, sometimes a drip in hospital

Immunosuppressants

thiopurines, methotrexate

They calm the immune system. Often combined with a biologic to stop the body making antibodies against it.

AzathioprineImurel6-mercaptopurinePurinetholMethotrexateMetoject, Imeth: Crohn'sCiclosporinin hospital, severe UC

Who for : Crohn's and UC. They take 2 to 3 months to work. TPMT test before azathioprine, regular blood tests, sun protection. Methotrexate: just one dose a week.

How : Tablets, or an injection for methotrexate

Biologics

antibodies

Each one blocks a specific inflammation signal. Biosimilars are as effective as the original.

Anti-TNFRemicade, Humira, Simponi (UC) and biosimilarsAnti-integrinEntyvioAnti-IL-12/23Stelara and biosimilarsAnti-IL-23Skyrizi, Omvoh, Tremfya

Who for : Moderate to severe Crohn's and UC. Before starting: screening for infections (tuberculosis, hepatitis, HIV, chickenpox) and vaccinations up to date.

How : Injections at home or drips in hospital

Targeted tablets

small molecules

Tablets that cut a relay of inflammation inside the cells, or hold back white blood cells.

JAKRinvoq (Crohn's, UC), Xeljanz (UC), Jyseleca (UC)S1PZeposia, Velsipity (UC)

Who for : Moderate to severe Crohn's and UC depending on the molecule. They work quickly. Monitoring with blood tests; caution for some (heart, clots, shingles).

How : Tablets, once or twice a day

Alongside the staircase

SurgeryA tool like any other, not a failure (see the dedicated sheet).

AntibioticsFor some fistulas or infections.

Nutrition100% liquid nutrition treats Crohn's flares in children.

DeficienciesIron, vitamin D, B12… to be corrected (sheet “Tiredness”).

Good to knowIn France, availability and reimbursement vary from one molecule to another: your gastro will tell you what is possible for you. Under each molecule: its brand name or a detail.