IBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD HorizonIBD Horizon
HIBD Horizon

Part 2 · Getting treatment today · 6/22

How your treatments work

Why there are several families of treatment, and why you can switch between them.

Each treatment has its stepInflammation follows a chain, from the alarm to the damaged bowel wall. Some treatments cut the chain at one precise point, others calm the whole chain. Here are all the treatments available today.
1. The alarm

The gut's defences overreact, often to microbes.

Blocked by
No treatment here yet: it is one of the leads for tomorrow.
2. The messengers

Signals (TNF, IL-12, IL-23) give the order to inflame the bowel.

Blocked by
Anti-TNFRemicade, Humira, Simponi (UC) and biosimilarsAnti-IL-12/23Stelara and biosimilarsAnti-IL-23Skyrizi, Omvoh, Tremfya
3. The relay inside the cell

The message is passed on inside the white blood cells by the JAK family.

Blocked by
Anti-JAKRinvoq, Xeljanz, Jyseleca
4. Leaving the lymph nodes

Activated white blood cells leave the lymph nodes and head for the bowel.

Blocked by
S1P modulatorsZeposia, Velsipity
5. Getting into the bowel

They use a “key” (α4β7) to get into the bowel wall.

Blocked by
Anti-integrinEntyvio
6. Inflammation of the bowel wall

The white blood cells damage the bowel wall: pain, diarrhoea, blood, ulcers.

Blocked by
MesalazinePentasa, Fivasa, RowasaSulfasalazineSalazopyrine

And those that act on the whole chain

Cortisone

It quickly puts out the whole chain, but only for the length of a flare. Budesonide acts mainly in the bowel, with fewer effects on the rest of the body.

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

They slow down the activation and multiplication of lymphocytes, broadly and slowly (2 to 3 months). They also help biologics stay effective.

AzathioprineImurel6-mercaptopurinePurinetholMethotrexateMetoject, Imeth: Crohn's, 1 dose a weekCiclosporinin hospital, severe UC
The key message

When a treatment stops working, the next one is often chosen to cut the chain at a different point. Example: after an anti-TNF, you can move to an anti-IL-23, to Entyvio or to a JAK tablet. There is almost always another option.