Like many diseases, Crohn’s symptoms vary in intensity from patient to patient. Because of this, different medications are used to treat the disease based on its severity. Medications for Crohn’s Disease generally fall under four categories: Anti-inflammatory drugs, immune system suppressors, biologics and antibiotics.
Anti-inflammatory drugs are usually the first course of treatment for Crohn’s, as inflammation is at the core of the symptoms suffered. They can include the following:
- Oral 5-aminosalicylates (5-ASAs): These drugs are prescribed if the disease affects the patient’s colon. However, 5-ASAs are limited to treating the colon and do not prove beneficial if the disease affects the small intestine. They include sulfasalazine (Azulfidine®) and mesalamine (Pentasa®, Asacol®, Lialda®, Apriso®, Delzicol®). These drugs are given in a number of ways, either orally, or in suppositories or enemas. 5-ASAs were once widely used but are not considered to be less effective than they once were. And since they come with unpleasant side effects (sulfasalazine, for example, can cause nausea, vomiting, loss of appetite and more), doctors aren’t prescribing them as frequently as they once did.
- Corticosteroids: Prednisone is a popular corticosteroid which is commonly used to reduce inflammation in the small intestine and colon. Prednisone may be prescribed to quickly bring a flare-up under control. However, these drugs can cause multiple negative side effects, ranging from facial swelling, sweating, insomnia and weight gain in the short-term to high blood sugar, osteoporosis and increased risk of infection when taken over a long-term basis. Because of this, doctors prefer to prescribe steroids for the shortest length of time possible. However, they can improve symptoms to the point of remission, so many patients would rather take them than not.
Immunosuppressants are used to treat Crohn’s because the disease is, in effect, a result of the immune system attacking a perceived threat by causing inflammation throughout the body. These drugs are usually prescribed once anti-inflammatories have ceased to be as effective. They may also be prescribed at the same time as anti-inflammatories in order to increase the chances of remission. Immunosuppressants include:
- Azathioprine (Imuran®) and mercaptopurine (6-MP, Purinethol®): These are the most commonly prescribed immunosuppressant medications prescribed for Crohn’s Disease. It’s advised that patients maintain close follow-up with their doctor in order to have regular blood tests performed, as these drugs can cause side effects ranging from lowered resistance to infection and liver inflammation to cancers including skin cancer and lymphoma.
Biologic therapies for Crohn’s are intended to target specific cells or molecules in the body. Biologics are reserved for both adults and children with moderate-to-severe Crohn’s who have not had results from other treatments. All of these therapies leave patients open to infection and should not be administered to a patient who is currently battling an infection. There are currently four such therapies approved for treating Crohn’s:
- Infliximab (Remicade®): This treatment is given intravenously by a doctor or nurse, usually every 2 to 8 weeks depending on the patient’s length of treatment, and takes two hours to be fully administered.
- Adalimumab (Humira®): This medication can be administered at home by the patient via an injection under the skin. Common side effects are relatively mild, ranging from injection site irritation to joint pain, nausea and headache.
- Certolizumab (Cimzia®): This medication can be administered either by a healthcare professional or at home via an injection under the skin. Common side effects are headache, respiratory infections, nausea and injection site reactions.
- Natalizumab (Tysabri®): This treatment is only available through a distribution system called the TOUCH program, and it is given via intravenous infusion every four weeks. This has been associated with progressive multifocal leukoencephalopathy (PML), a rare but serious infection. Common side effects include fatigue and headache.
Antibiotics are used to treat Crohn’s Disease even though bacteria have not been identified as the cause of the disease. Still, these drugs may reduce intestinal bacteria and suppress the immune system. Antibiotics can also heal fistulas and abscesses in Crohn’s sufferers. Flagyl® and Cipro® are the most commonly prescribed antibiotics for Crohn’s.
Given the many options available to Crohn’s patients, it’s important to have a conversation with your doctor and find out which one would work best for you. Be sure to ask them about side effects, what you should be aware of in relation to long-term consequences and any tests you’ll need to take to monitor your health (as in the case of immunosuppressors and biologics). As long as you and your doctor work together and keep communicating, there’s no reason why you shouldn’t be able to manage your symptoms and get back to living your life fully.
The product names used in this web site are for identification purposes only. All registered trademarks are the property of their respective owners.