What Are DMAIDs?

Disease-modifying anti-inflammatory bowel disease drugs (DMAIDs) are a group of prescription drugs for certain autoimmune conditions, where an overactive immune system causes inflammation and pain. 

Types of DMAIDs 

There are two main types of DMAIDs: 

Traditional DMAIDs. They’re also called immunosuppressants or immunomodulators. Your doctor may prescribe one of these older, conventional DMAIDs first.

Biologics. These are protein-based DMAIDs made in a lab. They target certain inflammation-causing molecules, cells, and pathways.

How Do DMAIDs Work?

With UC, your immune system is too active. It mistakes healthy cells for foreign invaders and attacks them. Different DMAIDs target certain pathways and proteins in your immune system to help stop it from attacking healthy tissue.

What DMAIDs Are Prescribed for UC?

Beyond traditional DMAIDs, doctors also prescribe the following DMAIDs for UC:

When Are DMAIDs Prescribed for UC? 

Your doctor may first prescribe a traditional DMAID if you have mild or moderate UC or are trying to keep your symptoms in remission.

How Do You Take DMAIDs?

How you take a DMAID, and how often, depends on the type of medication. You’ll usually take a traditional DMAID as a pill. You’ll take a biologic DMAID as a shot or IV into a vein. JAK inhibitors (tofacitinib and upadacitinib) come as tablets.

How Effective Are DMAIDS for Ulcerative Colitis? 

Many things play a role in how effective different drugs can be for certain conditions. Studies that have looked at how effective DMAIDS are at helping people with UC achieve remission have shown results like these:

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Are DMAIDs for UC Safe?

Side effects vary between the different types of DMAIDs, and they also vary for each individual drug.

You should avoid DMAIDs, especially biologic DMAIDs, if you have:

  • An active infection
  • Low stem cell levels in your bone marrow
  • An immunodeficiency disorder that affects your ability to fight infections and diseases
  • Are pregnant or nursing, since they could harm your baby. 

 Your doctor will review your medical history and test results to make sure DMAIDs are safe and right for you.

Side Effects of DMAIDs

  • A greater chance of bacterial, fungal, and viral infections
  • The return of dormant infections like tuberculosis, shingles (herpes zoster), or hepatitis B and C

Some biologics may cause higher cholesterol, low blood cell counts, and raised liver enzymes. With JAK inhibitors, there may be a higher chance of blood clots. 

There may be more side effects specific to the DMAID you're taking. Your doctor will go over possible side effects with you, and if you have any troubling symptoms, be sure to contact them. They may also check your blood regularly to keep an eye out for serious side effects.

How Much Do DMAIDs for UC Cost?

DMAIDs can be pricey, costing tens of thousands of dollars a year out of pocket. Biologics are more expensive than traditional DMAIDs because you take them as an IV infusion at a hospital or clinic. 

Here are some ideas to help bring down your costs for these drugs:

Talk to your pharmacist. They may be able to share lower-cost, affordable prescription savings programs.

Enroll in drugmaker programs. Drug companies offer free or discounted drugs through patient assistance programs for people without health insurance. 

Ask your doctor about biosimilars. Biosimilar drugs are almost exact copies of biologics. For example, Abrilada is one of the biosimilars to adalimumab. Renflexis is a biosimilar to infliximab. Each of these copycat medicines works in the same way as the biologic it was designed to mimic. It has the same safety profile but often costs less.

Clinical Trials for DMAIDs for UC

Clinical trials are research studies where you volunteer to help answer specific health questions. They’re designed to find new treatments and improve health safely. Researchers carry out clinical trials to:

  • Test if new drugs or treatments are safe and work well
  • Find better ways to use existing treatments
  • Learn how treatments work in different groups of people, like children or minorities

Some people join clinical trials to help advance medical knowledge. It’s essential to include people from diverse backgrounds in clinical trials because different groups may respond to treatments in unique ways.

Ask your doctor about clinical trials for DMAIDs or search databases like ClinicalTrials.gov to find studies that might be a good fit for you.

Drug companies, universities, hospitals, government agencies, and other organizations sponsor trials. They usually take place in medical centers or research institutions.

Both volunteers and researchers must follow strict rules to make sure those who take part in clinical trials stay safe. The FDA has regulations to protect you. Before joining, volunteers learn all about the study, including potential risks. You must sign a consent form confirming your understanding of the trial.

Are DMAIDs for UC Right for Me?

You and your doctor will discuss the pros and cons of taking DMAIDs for ulcerative colitis to decide if this medication is right for you. You’ll consider:

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Medical history. People with some health conditions may need to avoid certain DMAIDs but will be able to take others. 

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Disease stage, extent, and severity. Treating UC also depends on the stage of your disease (active or in remission), its extent, and how serious it is. Your doctor may also first have you try a traditional DMAID, and if it doesn’t work, switch to a biologic.

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Side effects. All medicines have potential side effects. Ask your doctor about common and serious side effects, so you know what to watch out for.

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Cost. If cost is a concern, ask if insurance covers the DMAID or if there are less expensive alternatives like biosimilars.

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Delivery method. While you can take some DMAIDs as a pill, others need an IV, which means more time at a hospital or clinic.

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How long it could take to start working. Some medicines work quickly, but it can take several weeks or months to see the benefits of a DMAID.  

Show Sources

SOURCES:

Mayo Clinic: “Ulcerative colitis,” “Upadacitinib (oral route),” “Tofacitinib (oral route),” “Methotrexate (oral route),” “Infliximab (intravenous route),” “Adalimumab (subcutaneous route),” “Golimumab (intravenous route, subcutaneous route),” “Vedolizumab (intravenous route, subcutaneous route).” 

Cleveland Clinic: “Disease-Modifying Antirheumatic Drugs (DMARDS),” “Biologics (Biologic Medicine).” 

National Health Service (U.K.): “Ulcerative Colitis.”

eClinical Medicine: “Efficacy and safety of methotrexate in the management of inflammatory bowel disease: A systematic review and meta-analysis of randomized, controlled trials.”

Seminars in Arthritis and Rheumatism: “Medicare expenditures for conventional and biologic disease modifying agents commonly used for treatment of rheumatoid arthritis.”

Consumer Reports: “How to Get Free or Discounted Prescription Drugs During the Coronavirus Crisis.”

FDA: “9 Things to Know About Biosimilars and Interchangeable Biosimilars,” “Basics About Clinical Trials,” “Zymfentra prescribing information,” “Simlandi prescribing information.”

Arthritis Foundation: “Biosimilars: What You Should Know.”

StatPearls: “Disease-Modifying Antirheumatic Drugs (DMARD).”

Medscape: “Ulcerative Colitis Treatment & Management,” “ustekinumab (Rx).”

HealthDirect: “Questions to ask before taking a medicine.”

Frontiers in Immunology: “Efficacy and Safety of Adalimumab Biosimilars: Current Critical Clinical Data in Rheumatoid Arthritis.”

The New England Journal of Medicine: “Mirikizumab as Induction and Maintenance Therapy for Ulcerative Colitis,” “Vedolizumab as Induction and Maintenance Therapy for Ulcerative Colitis,” “Tofacitinib as Induction and Maintenance Therapy for Ulcerative Colitis,” “Upadacitinib Induction and Maintenance Therapy for Crohn’s Disease.” 

MedlinePlus: “Tofacitinib.” 

Gastroenterology: “Adalimumab Induces and Maintains Clinical Remission in Patients With Moderate-to-Severe Ulcerative Colitis,” “Subcutaneous golimumab maintains clinical response in patients with moderate-to-severe ulcerative colitis,” ”AGA Clinical Practice Guidelines on the Management of Moderate to Severe Ulcerative Colitis.”

Journal of Gastroenterology: “Efficacy and safety of golimumab 52-week maintenance therapy in Japanese patients with moderate to severely active ulcerative colitis: a phase 3, double-blind, randomized, placebo-controlled study-(PURSUIT-J study).”

Canadian Journal of Health Technologies: “Infliximab (Remsima SC).”

Gastroenterology and Hepatology: “Efficacy and Safety of Mirikizumab as Maintenance Therapy in Patients With Moderately to Severely Active Ulcerative Colitis: Results From the Phase 3 LUCENT-2 Study,” “The Efficacy and Safety of Guselkumab Induction Therapy in Patients With Moderately to Severely Active Ulcerative Colitis: Results From the Phase 3 QUASAR Induction Study.”

American College of Gastroenterology: “Risankizumab Is Superior to Placebo for Induction and Maintenance of Moderate-Severe Ulcerative Colitis (UC): Assessing the UC  Treatment Paradigm.”