What is the stepwise approach to treating inflammatory bowel disease (IBD)?

Updated: Apr 10, 2020
  • Author: William A Rowe, MD; Chief Editor: BS Anand, MD  more...
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The stepwise approach is as follows:

  1. Aminosalicylates and symptomatic agents are step I drugs; antibiotics are step IA drugs, given the limited situations in which they are used

  2. Corticosteroids constitute the step II drugs, which are to be used if the step I drugs fail to adequately control the IBD

  3. Immune-modifying agents are step III drugs and are used if corticosteroids fail or are required for prolonged periods; infliximab and adalimumab are also step III drugs

  4. Step IV drugs are experimental agents, are used only after the previous steps fail, and are administered only by physicians familiar with their use

Note that drugs from all steps may be used additively; in general, the goal is to wean the patient off steroids as soon as possible to prevent long-term adverse effects from these agents. Opinions differ regarding the use of certain agents in this stepwise approach.

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