IBD Drug Regimens (Kind of)

Mild-moderate UC; proctitis

5-ASA (rectal)

Mild-moderate UC; proctitis or left-sided colitis

5-ASA (rectal) enema

Mild-moderate UC; left-sided colitis

5-ASA (rectal) enema + 5-ASA oral

Extensive colitis

5-ASA oral

Mod-severe UC

Can do induction with budesonide MMX or oral corticosteroids (≤8 weeks)

• If so, do maintenance with azathioprine afterward

Can do induction with any of the other agents except the excluded agents

• If so, do maintenance with the same agent afterward

• Excluded agents: “5-ASA went to do another Cycle of Meth with Certainty.”

Fulminant UC

Induction with either:

• Methylprednisolone

• Hydrocortisone

If no remission after 3-5 days of this, switch to either:

• Infliximab

• Cyclosporine

Then choose maintenance agent:

• If responsive to infliximab for induction, continue infliximab

• If responsive to cyclosporine for induction, use azathioprine or vedolizumab

Mild-moderate CD; ileocecal

Budesonide

Moderate-severe CD

Can do induction with oral corticosteroids

• If so, do maintenance with azathioprine/6-MP or methotrexate

Can do induction with any of the other agents except the excluded agents

• If so, do maintenance with the same agent afterward

• Excluded agents: “5-ASA then went Tofaci to get a Cycle of Sips.”

Severe-fulminant CD

Do induction with methylprednisolone

After that, do maintenance with one of the following anti-TNFs:

• Infliximab

• Adalimumab

• Certolizumab pegol

*Note: golimumab is only anti-TNF not used here; it’s only for mod-severe CD (and mod-severe UC)