Posted 7/19/2017 1:10 PM (GMT 0)
There's three classes of UC meds that are generally consider stronger as you progress up them, and also rescue meds which are set aside all on their own.
Short-term rescue meds are things like prednisone and cyclosporine that get us out of a bind due to their quick-working nature and are very effective but not meant for long term usage. High doses of IV steroids or IV cyclosporine are very powerful medications that can make even those of us with the worst possible cases feel completely normal (even those of us who ultimately need a surgery). However, the permanent side effects just do not make them sustainable.
The first class of UC medications it the 90% topical anti-inflammatory 5ASA/Mesalamines like lialda, asacol, rowasa, and canasa. Very mild medications, in the greater scope of things but effective for many.
The second class of UC meds is immunomodulators (IMuran/Azathioprine or 6MP) and these medications work by intentionally lowering the amount of white blood cells your body can produce. When we flare our WBC count goes through the roof. WBC are the immune system's attack dog directly causing inflammation within your body. The less WBC you have, the less inflammation your immune system can cause, and the better your UC symptoms are.
The third class of UC meds is biologics like Humira/remicade or entyvio. These are biologically-engineered proteins that interfere with the immune system's natural ability to signal, initiate, and complete an attack. The immune system uses a series of messenger proteins during that process. The most commonly and longest used biologics are tnf-alpha-blockers like humira/remicade, which are proteins designed to block the immune system's initial signaling battle cry "send an attack over here". If that battle cry can be muted or at least muffled, then our UC symptoms improve.
There is no single, silver bullet that works best over everything else. Rather, combining multiple (or even all) classes of UC medications often produces the best results. Add some anti-inflammatory 5ASA power, reduce the amount of WBC there are available, and blocking the signaling for an attack cumulatively can often put us into a remission. And remember, it often takes less medications to sustain a remission than it initially did to achieve it.