Fatigue in Inflammatory Bowel Disease: The Role of Drug Therapy Within a Holistic Management Framework

Fatigue is one of the most common and disabling symptoms experienced by individuals with inflammatory bowel disease (IBD). Significant fatigue is experienced by approximately 40-80% of adults with IBD, with higher prevalence during active disease states but persisting in up to one-third of individuals who are in clinical remission. Fatigue is not solely a consequence of disease activity, but rather a unique and multifactorial manifestation of IBD. In this narrative review we synthesize evidence on the various mechanisms of fatigue in IBD, as well as pharmacological agents to address fatigue both directly or through secondary contributors including anaemia, psychiatric comorbidities, sleep disturbance, and pain. The review further situates pharmacological therapy within a holistic framework that integrates non-pharmacological approaches as part of a multidisciplinary approach to fatigue in IBD. Drug therapy has a meaningful role in this context, both when targeting disease-related inflammation and secondary contributors to fatigue. However, the evidence base for most of these approaches remains weak. It is clear that no single pharmacological agent will resolve IBD-related fatigue in isolation, but effective management should identify a patient's dominant contributors and address them systematically with both drug and nondrug intervention strategies. This framework should be delivered by a multidisciplinary team through an integrated care approach and optimally be guided by the patient's priorities and goals.