IBD Treatment Options: Understanding Your Risks and Benefits
Written by: CDHF
Updated: March 19th, 2026
This content was reviewed by gastroenterologist Dr. Christopher Ma, MD, MPH, FRCPC, in October 2025.
Click below to view and download the brochure in each language:
Inflammatory bowel disease (IBD) affects nearly 1% of Canadians and refers to chronic inflammation of the digestive tract that occurs when the immune system mistakenly targets the bowel. The two main types, Crohn’s disease and ulcerative colitis, cause alternating periods of active symptoms known as flares and times of remission when symptoms ease. Though IBD has no cure, advances in treatment now allow most people to achieve long-term remission and live healthy, fulfilling lives. In the sections below, we will explore the different therapies used to manage IBD, including 5-ASA medications, steroids, immunosuppressants, biologics, and newer options like JAK inhibitors, and discuss the benefits and risks of each to help patients and caregivers make informed decisions about care.
What is Inflammatory Bowel Disease?
Inflammatory bowel disease (IBD) is a chronic condition for which there is currently no cure. It is a group of disorders involving chronic inflammation of the digestive tract. Like many chronic illnesses, IBD can alternate between significant episodes, known as flares, and periods of milder symptoms or no symptoms at all, referred to as disease remission. It can often be painful, may affect growth in children, and at times can lead to serious complications. The two main types of IBD are ulcerative colitis (UC) and Crohn’s disease (CD). Crohn’s disease may develop gradually or appear suddenly, and it can affect any part of the digestive tract from the mouth to the rectum, though it most often impacts the lower small intestine and the colon. Ulcerative colitis typically affects only the innermost lining of the rectum and large intestine (colon), starting in the rectum and extending continuously for varying distances through the large intestine.
It is important to understand the benefits and risks of treatment for this chronic disease. IBD is usually managed with a series of medications designed to reduce intestinal inflammation, control symptoms, and prevent long-term damage. The good news is that with proper treatment, patients can expect improved physical health, a higher quality of life, reduced abdominal pain, less fatigue, and decreased depression and anxiety. However, there is no clear roadmap for how IBD will progress, as each person’s experience is different, with peaks and valleys of symptoms over the years. To make the best treatment decisions, patients must balance the benefits and risks of medication against the dangers of no treatment at all. While all medications have side effects, not treating the disease is generally more dangerous. When treatment is tailored to the individual’s stage of disease, lifestyle, and personal circumstances, the benefits far outweigh the risks.
Most people living with IBD can lead fulfilling lives despite the challenges of the illness. Treatment helps maximize health by reducing complications, decreasing the number and frequency of flares, minimizing hospitalizations and surgeries, improving intestinal healing, enabling longer remission periods, and enhancing quality of life. Finding the right medication and consistently following the recommended treatment plan can help keep the disease under control. Achieving optimal health allows individuals to grow and develop physically, intellectually, emotionally, and socially.
Living with IBD
A flare refers to the symptoms experienced when inflammatory bowel disease (IBD) is active, causing tissue to become inflamed and irritated. The most common symptoms include abdominal pain and bloody diarrhea, but flares can also bring weight loss, fatigue, fever, achy joints, skin and mouth sores, and inflamed eyes. Complications are additional health problems that may arise as a result of living with this chronic condition. People with IBD may experience inflammation in other organs such as the eyes, skin, joints, liver, or bile ducts. Other possible complications include anemia, malnutrition, osteoporosis, bowel obstruction, ulcers, fistulas, anal fissures, and, in rare cases, colon cancer. In children, IBD can delay growth or sexual development.
Healing is an important focus in IBD treatment. The inner lining of the intestine, called the mucosa, becomes damaged during active disease. Mucosal healing—the restoration of healthy intestinal lining—is the target of all IBD treatments. Another challenge is the development of abnormal connections between the intestine and other organs, known as fistulas, which proper medication may help prevent.
Surgery for IBD is generally avoided unless absolutely necessary, as it often comes with pain, muscle loss, and risks such as reactions to anesthesia, bleeding, blood clots, heart attacks, and strokes. Surgery also increases the risk of infection during hospital stays and can disrupt personal relationships, work, and school. For these reasons, healthcare providers often recommend medical treatment to reduce the likelihood of needing surgery.
Adherence to treatment is essential. Because IBD is a chronic disease, medications should always be taken as prescribed, even during periods when symptoms are absent. The goal is to maintain mucosal healing and prevent future flares. Adherence, sometimes called compliance, refers to how well patients follow their treatment plan. This includes taking medications at the correct times, completing all doses, refilling prescriptions, and attending scheduled appointments for infusions or injections.
5-ASAs
5-aminosalicylic acid (5-ASA), also known as mesalamine, is a medication that reduces inflammation in the intestine, controls diarrhea, and helps maintain long-term remission. These medications are taken orally and may be used alone or in combination with immunosuppressants and steroids. The primary goal of 5-ASA therapy is to help patients with mild to moderate ulcerative colitis achieve and maintain remission. This is considered a very safe category of medication, with a very low risk of intolerance or allergic reactions. Before starting this treatment, your healthcare provider will review these minimal risks with you.
Steroids
Steroids rapidly reduce inflammation by suppressing the activity of immune cells. The most common stairs used to treat IBD circulate throughout the whole body. Some newer steroids target specific areas of the intestine and tend to have fewer side effects and less toxicity. It is very important for you to understand that steroids are meant to only be a short-term therapy to control acute flares and to achieve remission. They are not used to maintain remission. Steroids can be taken with your usual maintenance medications. This often means you’ll begin your treatment with a maintenance drug while still on steroids. Once your symptoms improve your doctor will carefully and gradually wean you off the steroid if that is appropriate. Depending on the exact location of the disease and how significant your symptoms are these steroids can be delivered orally, rectally, or intravenously.
We do have certain suggestions for you to follow when using steroids. Consider wearing a medical alert bracelet or necklace with a sterile name engrave. Ensure you get your blood pressure checked regularly while you’re on steroids and your healthcare provider will tell you if they’re worried about your blood sugar and will need you to get it checked at least once while on the steroids. It is very important that you also do not stop taking steroids on your own. Most of the time it is important to slowly wean your body from these drugs under direction of your healthcare provider.
The main risk of steroids is infection. High dos Terra therapy increases the risk of developing infections. Because of the high risk of infections steroids again are only used for short periods of time. There are also other common adverse effects of steroids. These will include acne, swelling of the face, osteoporosis with long-term use, glaucoma with long-term use, high blood pressure, eye cataracts with long-term use, and easy skin bruising.
Immunosuppressants
Immunosuppressants are drugs that suppress the immune system, thus reducing inflammation and preventing the body from mistakenly attacking its own digestive system.
Immunosuppressants aim to decrease the use of steroids and maintain remission for patients with moderate to severe disease. They have fewer and less side effects than steroids so they are used for longer periods of time. However, because they can take several months to achieve their full effect, they often are combined with steroids in the beginning. You can also use them with other medications to prevent your disease from flaring while you’re tapering off the steroids.
Commonly used immunosuppressants are azathioprine, also called imuran, 6-mercaptopurine is another name for it, and methotrexate. Immunosuppressants can be taken orally and methotrexate can be taken orally or by injection.
As they suppress the immune system, the risk of infection is anywhere from very low to medium risk, and this really depends on your general baseline health. These medications will be prescribed under the supervision of a healthcare provider so that they can individualize to you your actual risk of these medications. Of note, these medications can also be associated with a very low risk of cancers, and again this risk is still extremely low. The cancers that they have been associated with are non-melanoma skin cancers and a blood cancer called lymphoma, and again it is very important to talk to your healthcare provider about your own individual risk because everyone will have a slightly different absolute risk depending on other risk factors they may have, for example for skin cance
Please alert your healthcare provider, however, if you experience any of the following side effects while on this medication: yellowing of the skin or whites of eyes, dark urine or blood in your urine and stool, chest pain or stomach pain, fever or flu-like symptoms, shortness of breath, or loss of appetite.
The reason why we do use this class of medications is that there is research to show that they will decrease the incidence of flares.
Biologics & Biosimilars
Biologics and biosimilars. Biologics are proteins specifically engineered to block one or more inflammatory pathways in your body and thus reduce the inflammation that causes your IBD. A biosimilar drug has demonstrated to be highly similar to a biologic originator drug that’s already been authorized for sale, known as the reference biologic drug. Biosimilars, you may have heard, were previously known in Canada as subsequent entry biologics or SEBs. Health Canada only approves biosimilars for marketing in Canada when the manufacturer demonstrates that their product is of similar quality, safety, and efficacy to their original reference drug.
One class of these biologics blocks the action of a protein called tumor necrosis factor alpha (TNF), which your body makes naturally. If you have IBD, you produce more of this protein, causing inflammation and damage to healthy tissue. By suppressing TNF-alpha production, anti-TNF biologics reduce inflammation and damage to your intestinal tract. Another class of biologics blocks a receptor called integrin: this is required to target inflammation cells to the bowel. An example of an integrin blocker is vedolizumab. A third class of biologics targets an inflammation molecule called IL23: this is overproduced in patients with IBD and in inflamed tissue. Examples of IL23 blockers include ustekinumab, risankizumab, guselkumab, and mirikizumab. Importantly, biologic treatments do not shut off the entire immune system. They are specifically designed to block parts of the immune system that are overactive or abnormal in IBD, and therefore, they help to induce and maintain remission for patients with moderate to severe disease. More importantly, they are the only class of medications that has been shown in randomized control trials to achieve mucosal healing. Sometimes biologics are used in combination with other inflammatory bowel disease medicines to achieve better treatment effect or reduce the risk of developing antibodies against the biologic.
Biologics are delivered in one of two ways: through intravenous infusion by a healthcare provider at a clinic, or by subcutaneous injection which you can do yourself at home or have done by a trained nurse at your home or in a clinic. These are treatments that are not given every day, but rather are given every few weeks to months.
| Originator biologic and it’s biosimilars | |
| Adalimumab | Golimumab |
| Humira® – Injection | Simponi® – Injection |
| Abrilada® – Injection | |
| Amgevita® – Injection | Guselkumab Tremfya) |
| Hadlima® – Injection | |
| Hyrimoz® – Injection | Mirikizumab |
| Hulio® – Injection | Omvoh™ – Injection/Infusion |
| Idacio® – Injection | |
| Simlandi™ – Injection | Risankizumab |
| Yuflyma™ – Injection | Skyrizi® – Injection/Infusion |
| Infliximab | Ustekinumab |
| Remicade® – Infusion | Stelara® – Injection/Infusion |
| Avsola™ – Infusion | Steqeyma® – Injection/Infusion |
| Ixifi® – Infusion | Wezlana™ – Injection/Infusion |
| Omvyence™ – Infusion | |
| Remdantry™ – Infusion | Vedolizumab |
| Remsima™ SC – Injection | Entyvio® – Injection/Infusion |
| Renflexis™ – Infusion | |
Pediatric indications
Indications for children vary depending on age, weight, severity of disease, and previous failure of other conventional and/or biologic treatments. Your discussions with your physician will establish the most appropriate treatment.
The Risk of Biologics
Because of their specific design, biologics are overall, very safe medications to use long-term. There is extensive safety data with biologics both for IBD and for use in treating other immune-mediated diseases of the skin and joints. There is a very low risk of serious infection. Biologics in general are considered the safest treatment option in terms of infection in comparison to immunosuppressants and systemic steroids. It is very rare to have an allergic reaction to biologics, and it is not higher in biologics compared to other non-biologic medications. If the allergic reaction happens during your infusion, these reactions are actually very easily managed at the time of infusion and often managed by slowing the infusion rate or temporarily stopping the infusion until the reaction stops.
In terms of cancer risk, individuals using a biologic have a very low absolute risk of developing a cancer. It has been estimated that the risk of cancer related to biologic use is no higher than six out of a hundred thousand. However, your individual risk may vary depending on your own risk factors and your family history, and again it’s very important to have the conversation with your healthcare provider about your individual risk. Patients on biologic treatment should continue to get routine cancer screening: this may include screening for cervical cancer in women (by pap smear), skin checks through your family doctor, and regular colonoscopies with your gastroenterologist.
Other side effects to biologic treatment are extremely rare. Side effects like headache and fatigue can occur, but are not common. Other side effects depend on the type of biologic used: talk to your doctor about these risks.
The Benefits of Biologics
They are the only class of drugs that have been shown in randomized control trials to heal the mucosa. Among people taking biologics for IBD, it is generally accepted that fewer than one in five will have a disease flare within the first year of treatment, and that up to 40 to 70 percent of patients who start off with moderate to severe disease will have a clinical response. It is also estimated that up to 17 to 40 percent of patients who start with moderate to severe disease will go into clinical remission.
Unfortunately, stopping the biologic therapies may lead to disease relapse and flares in most patients, as there is no cure for inflammatory bowel disease. The majority of the time your healthcare provider will recommend taking these drugs on a long-term basis. Biologics can also protect you from complications after surgery. After surgery, it may be that you need to be on a biologic to prevent the next surgery. Again, biologics reduce inflammation and tissue damage in the GI tract.
Overall, we also know that IBD patients who take biologics have significantly lower hospitalization and surgical rates than those who do not use biologics. IBD patients taking biologics experience greater mucosal healing and longer periods of remission than those who do not use biologics. A fistula is an abnormal connection between your intestine and other organs. When patients develop fistulas, we know that they are very difficult to heal. The good news is up to 50 percent of IBD patients taking biologics may heal their fistulas compared to only 13 percent of those who do not use biologics.
We also know that patients who take biologics have been shown to experience improvement in their quality of life. They report having less abdominal pain, greater quality of life, improved physical health, significantly less depression, and less fatigue.
JAK Inhibitors
Jak Inhibitors or Janus kinase Inhibitors are a new oral treatment option for adult patients with moderate to severe ulcerative colitis that helps to achieve and maintain remission. Jak Inhibitors are small molecules in a pill form that interferes with a number of key pro-inflammatory cytokines involved in the origination and development of inflammatory bow disease. In contrast, all the other agents that we have been talking about, called biologics, are delivered through injectables or intravenous agents.
There are currently two JAK inhibitors available in Canada: Upadacitinib (Rinvoq, one pill once a day) and tofacitinib (Xeljanz, one pill twice a day). Rinvoq can be used in Crohn’s disease or ulcerative colitis. Xeljanz is only approved for UC.
In general, JAK inhibitors should not be used in combination with other therapies such as biologics or immunosuppression. Similar to biologics, the main risk of JAK inhibitors is the risk of infection. The most commonly reported infection is shingles: all patients who receive a JAK inhibitor should be vaccinated against shingles infection, which typically presents as a painful skin rash. If this develops on treatment, please contact your doctor immediately. Similar to the other medications we have talked about, there is always the very low risk of developing an allergic reaction. Similar to biologic therapies, there is a very low absolute risk of developing non-melanoma skin cancers that may be associated with using advanced therapies such as JAK Inhibitors, and again this depends on your background risk of developing Cancers. In patients with rheumatoid arthritis who have risk factors for heart disease and are >50 years old, Xeljanz was associated with a very small increased risk of heart events, cancer, and blood clots: these risks have not been shown in patients with IBD. You should look to your healthare provider and being able to give you the proper counseling to tell you what your own individual risk is.
Benefits of JAK Inhibitors include increased healing and longer periods of remission. JAK inhibitors help to promote mucosal healing in the gastrointestinal tract and have been associated with improved quality of life. As well, JAK Inhibitors are taken orally which means you can easily and conveniently do that at home or at work.
S1P receptor modulators
S1P receptor modulators are a new class of treatment available to treat moderate-to-severe ulcerative colitis. In Canada, etrasimod (Velsipity) is currently the only available S1P receptor modulator. It is a once daily pill. This medicine works by blocking inflammation cells, which are born in the bone marrow and mature in the lymph nodes, from getting to the bowel. Overall, etrasimod is a safe treatment for ulcerative colitis. The first dose of the medication is associated with a very slight reduction in heart rate; therefore, before starting treatment, all patients who are considering etrasimod should have an electrocardiogram (a non-invasive measure of your heart’s electrical current). In patients who have had eye problems (including patients with diabetes or with previous inflammation in the eye, called uveitis), a detailed eye examination should be done prior to starting etrasimod. The risk of infection, non-melanoma skin cancer, or allergic reactions to etrasimod is very low.
Emerging Treatments for IBD
Until we find a cure for inflammatory bowel disease you will expect to have IBD for the rest of your life. Current treatment options help control the disease and minimize your symptoms so that the majority of patients enjoy a healthy and fulfilling life. The good news is although we have not found the cure of this disease, we are constantly looking at new treatments to optimize efficacy, prove quality of life, reduce complications and reduce risk of being on that medication for patients.
Most importantly, by understanding all your medical options and their associated benefits and potential risk, you along with your health care provider make the best decisions about your health. To get the most out of your treatment, follow the plan you and your doctor have discussed and agreed upon as being the best for you, your condition, your situation and lifestyle. It is really important that you be involved in decisions about your treatment.
If you don’t understand something or you read something that is not in keeping with what you just heard from your healthcare provider, then please don’t be afraid to ask questions. If you find your drug regimen difficult to follow or wish to try out a different type of treatment, please speak to your healthcare provider and do not change or stop the treatment without doing so. If cost is a barrier, often there are multiple solutions that you may not be aware of, so again speak to your healthcare provider.
For your treatment to be successful, become a partner with your healthcare provider team, deciding on a treatment plan together, asking questions, and asking for more information, and letting your healthcare provider team know how things are going at every step of the way.
Below is a brochure CDHF created to help understand the benefits and risks of IBD treatment options. In addition to providing the brochure in English (and also in French on the French translation of our website), you will find the brochure below in both Mandarin & Punjabi.
This resource was made possible due to an unrestricted educational grant from Organon.
Learn more about Crohn’s disease. Learn more about Ulcerative Colitis.
Infliximab for the Treatment of Inflammatory Bowel Disease: An Overview of Drug History and Delivery
