Advances In IBD Treatment

Treating IBD used to be about easing symptoms, but that’s changed. Sure, medicines can tamp down inflammation, but that doesn’t stop the disease from getting worse. Now doctors focus on healing the inner lining of the intestinal tract – the intestinal mucosa – after ulcers appear. That can help people with IBD achieve remission or at least reduce hospital stays and surgery.

Knowing how severe your disease is (or may get) gives doctors a better idea of how to treat it. Colonoscopy is still the gold standard, but newer, noninvasive imaging options like computerized tomography (CT) enterography, magnetic resonance enterography (MRE), and bowel ultrasound let doctors see what’s happening in your intestines even when they’re inflamed or narrowed. That helps them decide what treatment is best for you. 

If you don’t respond to standard medicines like anti-tumor necrosis factor (anti-TNF) drugs, there’s hope. Drugs that block pro-inflammatory cytokines IL-12 and IL-23 show some promise. Golidocitinib, a JAK inhibitor used for cancer, has worked for Crohn’s disease but isn’t yet on the market. Boosting Pak2 protein to stop the IL-17 gene from producing inflammation may be another pathway for future ulcerative colitis drugs.

Biologics – drugs made from living organisms – can come with hefty price tags. Many insurers are strict about which ones they’ll cover and which ones they won’t. Want something similar but cheaper? Biosimilars are kind of like generic versions of traditional drugs. So far, these are the three for IBD available in the U.S., and all are biosimilars to infliximab (Remicade): infliximab-abda, infliximab-axxq, and infliximab-dyyb. 

Tofacitinib (Xeljanz), a type of drug known as a JAK inhibitor, was approved in pill form by the FDA to treat ulcerative colitis in 2018. Ozanimod (Zeposia) and upadacitinib (Rinvoq) followed a few years later.

Diets like the IBD-AID, specific carbohydrate diet, low-FODMAP diet, and Mediterranean-style eating have improved symptoms in people with IBD. Scientists are also studying how your gut health can impact your disease – and what you can do to alter and, perhaps, improve it. 

Putting mesenchymal stem cells into people with IBD eased symptoms, stopped inflammation, promoted mucosal healing, and healed perianal fistulas (an opening between the bowel and the skin near the anus in people who have IBD). Scientists can turn these stem cells into cells that do other jobs. Researchers also are studying stem cells to learn about (and test treatments for) intestinal fibrosis – scarring on the intestinal wall that’s common if you have IBD. 

Fecal microbiota transplantation, which can help people with ulcerative colitis, is when doctors take healthy bacteria from someone else’s poop and transfer it into your colon. The process usually requires a colonoscopy, endoscopy, or enema to insert the material through your rectum. Researchers are working on a pill that you could swallow instead.