LAWRENCE BRANDT, MD:
5-aminosalicylates are probably universally agreed-upon as the first line of therapy for a person who has mild to moderate illness. These are medications that are taken by mouth. They have their action in the colon. They could be taken by rectum, either by small enema or by suppository, and then their mode of action will be directed just in the rectum or the most distal part of the colon. But it’s a very well tolerated form of therapy with very, very few side effects. Most people will tolerate them very well.
Prescribed 5-aminosalicylates or 5-ASAs may include sulfasalazine, olsalazine, mesalamine and balsalazide.
Corticosteriods are another option available to patients.
DAVID RUBIN, MD:
Corticosteroids, like prednisone or methylprednisolone, are therapies that we use when the 5-ASA therapy hasn’t worked or when patients are sicker and need something that might work fast. One of the nice things about the steroids is that they work quickly, and patients will have some improvement in their symptoms in a short period of time. But we also know there are a lot of intolerable side effects of steroids, and we hate to use them if we could avoid them. We also know that steroids are not effective for maintenance.
STEPHEN HANAUER, MD:
The side effects can include increased appetite, weight gain, difficulty sleeping. I say that steroids make the highs high and the lows low. It can lead to a tendency towards diabetes, and long term can cause a thinning of the bones called osteoporosis, or cataract formation.
If patients have not responded to 5-ASAs or have needed corticosteriods to induce remission, doctors often prescribe an immunomodulator.