People with inflammatory bowel disease (IBD) often feel extremely tired, which affects their work and daily life. Researchers reviewed 10 studies involving nearly 3,000 IBD patients to see which medicines help with this fatigue. They found that some newer medications like vedolizumab and upadacitinib showed promise, while vitamin B12 supplements didn’t help. High doses of thiamine (vitamin B1) helped some patients, but lower doses didn’t work as well. The research shows we still need more studies to find the best treatments for IBD-related fatigue.

The Quick Take

  • What they studied: Which medicines can help reduce extreme tiredness in people with inflammatory bowel disease (IBD)
  • Who participated: Nearly 3,000 people with IBD from studies published between 2017 and 2024. About 1,664 had Crohn’s disease, 1,215 had ulcerative colitis, and 56 had irritable bowel syndrome
  • Key finding: Three medicines showed promise for reducing fatigue: vedolizumab, upadacitinib, and modafinil. However, vitamin B12 didn’t help, and only high-dose thiamine (vitamin B1) showed benefits
  • What it means for you: If you have IBD and feel constantly exhausted, talk to your doctor about these newer medications. However, this research is still early, so don’t expect immediate solutions. More research is needed to confirm which treatments work best for different people

The Research Details

Researchers conducted an integrative review, which means they searched through medical databases and carefully selected the best studies about medicines for IBD fatigue. They looked at studies published from 2017 to 2024 and found 10 high-quality studies that specifically measured fatigue and tested medicines. This approach helps doctors understand what treatments have the most evidence behind them.

The researchers used four major medical databases (PubMed, Lilacs, SciElo, and Cochrane) to find relevant studies. They started with 294 studies but narrowed it down to 10 that met strict requirements. Each study had to measure fatigue as a main goal and test actual medicines on IBD patients. By combining information from these 10 studies, the researchers could see patterns about which treatments seemed to work.

This type of review is important because it brings together all the best available evidence in one place. Instead of relying on one small study, doctors and patients can see what multiple studies show. This helps identify which medicines are worth trying and which ones probably won’t help. It also shows researchers where more studies are needed.

This review included nearly 3,000 patients across multiple studies, which makes the findings more reliable than a single small study. However, the researchers noted that only 10 studies met their strict requirements, which means research on this topic is still limited. The studies looked at real medicines tested on real patients, not just laboratory experiments. The main limitation is that the available studies weren’t all designed the same way, making it harder to compare results directly.

What the Results Show

The review found that three medicines showed promise for reducing fatigue in IBD patients. Vedolizumab and upadacitinib are newer medications that work by calming the immune system’s overactive response in the gut. Modafinil is a medicine that helps people stay alert and awake. These three medicines reduced fatigue symptoms in the studies reviewed.

Vitamin B12 supplements did not help reduce fatigue in IBD patients, even though doctors sometimes recommend them. This was surprising to many researchers because B12 is often used to treat tiredness in other conditions. High doses of thiamine (vitamin B1) at 300 mg or higher did reduce fatigue, but lower doses didn’t show the same benefit. This suggests that the amount of medicine matters significantly.

The researchers emphasized that while these findings are encouraging, the number of studies is still small. Only 10 studies met the strict requirements for this review, and some of these studies were small or had different designs. This means doctors can’t yet say with complete confidence which medicine works best for which patient.

The review also found that fatigue in IBD patients is connected to several other problems, including poor sleep, anxiety, depression, low iron levels (anemia), and use of steroid medications. This suggests that treating fatigue might require addressing these related issues too. The research showed that fatigue is a bigger problem for IBD patients than many doctors realize—it causes more missed work days than even abdominal pain, which is the main symptom of IBD.

This review adds to growing evidence that fatigue in IBD is a serious problem that needs specific treatment. Previous research has mostly focused on treating the gut inflammation itself, but this review shows that fatigue doesn’t always improve just by treating the IBD. The findings suggest that doctors may need to use additional medicines specifically targeting fatigue, not just the underlying disease.

The biggest limitation is that only 10 studies were found that met the strict requirements, even though researchers searched through 294 studies. This means research on this topic is still very limited. The studies that were included weren’t all designed the same way, making it difficult to compare results directly. Some studies were small with only a few patients. The review also couldn’t determine the best dose for some medicines or which patients would benefit most from each treatment. More research is needed before doctors can make strong recommendations.

The Bottom Line

If you have IBD and severe fatigue, discuss these options with your gastroenterologist: (1) Vedolizumab or upadacitinib—newer immune-calming medications that show promise (moderate confidence level); (2) High-dose thiamine (vitamin B1) at 300 mg or higher may help, though more research is needed (low-to-moderate confidence); (3) Modafinil for alertness, though this should only be considered under medical supervision (low-to-moderate confidence). Do not rely on vitamin B12 supplements alone for fatigue relief. Always work with your doctor to find the right treatment for your specific situation.

This research is most relevant for people with IBD who experience significant fatigue that affects their work or daily life. It’s also important for gastroenterologists and primary care doctors treating IBD patients. Family members may benefit from understanding that IBD fatigue is a real medical problem, not laziness. People with other conditions causing fatigue should not assume these treatments will work for them without consulting their doctor.

Don’t expect immediate results. Based on the studies reviewed, it typically takes several weeks to months to notice improvements in fatigue when starting a new medicine. Some people may see benefits within 2-4 weeks, while others may need 8-12 weeks. It’s important to give the medicine time to work while staying in close contact with your doctor about your progress.

Want to Apply This Research?

  • Create a daily fatigue log rating your energy level from 1-10 each morning and evening. Also track sleep quality, mood, and any medicines you’re taking. This helps you and your doctor see patterns and determine if a medicine is actually helping
  • If your doctor prescribes one of these medicines, set daily reminders to take it at the same time. Use the app to track not just fatigue, but also related factors like sleep, stress, and work absences. This creates a complete picture of how the medicine affects your life
  • Track fatigue weekly and review trends monthly with your doctor. Note any changes in sleep, mood, work performance, or ability to do activities you enjoy. If fatigue doesn’t improve after 8-12 weeks, discuss alternative treatments with your doctor. Continue tracking even after finding an effective treatment to ensure it keeps working

This review summarizes research about medicines for IBD-related fatigue but is not medical advice. The findings are based on limited studies, and more research is needed. Do not start, stop, or change any medicines without talking to your doctor first. Individual responses to treatment vary greatly. Always work with your healthcare team to develop a treatment plan tailored to your specific condition. If you experience severe fatigue, depression, or other concerning symptoms, contact your doctor immediately.