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It is believed that IBD is caused by an overactive immune system. Immunomodulators work by quieting down the immune system, helping to reduce inflammation. They can be given orally or by injection. Examples of immunomodulators are azathioprine, cyclosporine, 6-mercaptopurine, and methotrexate (for Crohn’s disease).

Benefits & risks of Immunomodulators

Potential benefits

  • Can help achieve and maintain remission
  • Allows patients to stop taking corticosteroids sooner
  • Helpful for people who don’t respond to other IBD medications
  • Good choice for people who have experienced side effects with corticosteroids
  • Useful in treating certain IBD complications, like fistulas (abnormal channels that connect different parts of the intestine)

Source:, "Immunomodulators"

Potential risks/side effects

  • Headache
  • Nausea
  • Vomiting
  • Diarrhea
  • Feeling ill
  • Rash
  • Fever
  • Hepatitis (inflammation of the liver)
  • Increased risk of infection
  • Canker sores
  • Low white blood cell count
  • Pancreatitis (inflammation of the pancreas)
  • Some forms of cancer (see Note below)

Note about cancer and immunomodulators

There is evidence that a small number of patients treated with 6-mercaptopurine and azathioprine may develop a type of lymph node cancer called non-Hodgkin lymphoma. Thankfully, it only occurs in approximately 4-9 people out of 10,000 who are treated over the course of a year. This is only slightly higher than the number of people who get this type of cancer without taking immunomodulators. In addition, some types of skin cancers may occur when taking immunomodulators. Because of this, a general recommendation is for annual skin exams when taking these medications.

Learn more about IBD medications and potential side effects in the CCFA brochure Understanding IBD Medications and Side Effects.