Crohn’s disease is characterized by chronic intestinal tract inflammation. It interferes with food digestion, nutrient absorption, and waste elimination. Crohn’s disease can progress to cause permanent damage to your bowels if left untreated.
It can even lead to life-threatening complications such as a bowel obstruction or colon cancer.
There’s no cure for Crohn’s, but there are treatment options that can cause remission. The goal of treatment is to:
- reduce or eliminate inflammation
- stop intestinal damage
- produce and maintain remission
Medical treatment for Crohn’s consists of conventional medications and biologics. Biologics are effective at putting Crohn’s into remission and keeping it there. But these treatments can put you at a higher risk for infection and certain cancers.
Read on to learn about the different approaches to Crohn’s treatment and the medications commonly prescribed.
Treatments for Crohn’s have evolved to include medication called biologics, made from living cells. Biologics target the inflammation process. They were designed to treat moderate to severe Crohn’s and are often the next step in treatment after conventional therapies haven’t worked.
Biologics promote bowel healing and bring about and maintain remission. They don’t suppress the overall immune system the way some medications do because they target specific mechanisms of the inflammation process. However, they do reduce infection resistance and increase cancer risk.
Biologics work in one of two ways:
- Anti-TNF biologics target the inflammation-causing protein tumor necrosis factor (TNF).
- Integrin blocker biologics and selective adhesion molecule (SAM) inhibitors stop inflammation-causing cells from finding vulnerable areas in the gut so it has time to heal.
Traditionally, biologics have been used as part of a step-up approach when other treatments fail to produce desired results. Guidelines now support choosing an appropriate therapy based on prognosis.
This means that, in those with significant disease, biologics can be given right away and may be able to prevent some damage before it starts.
Biosimilars are copies of biologics that have expired licenses. This is comparable to how some brand-name drugs have generic versions. However, because these drugs are made from biological materials and are very complex, they’re not identical to the originals.
They’re similar enough to be safe and to work well — and they’re more cost effective.
Antibiotics are used to treat infections that occur because of Crohn’s. They can also help your symptoms by reducing the number of bacteria in the intestines.
In Crohn’s disease, the immune system overreacts and can mistakenly attack intestinal bacteria, resulting in your symptoms.
These medications help treat mild to moderate Crohn’s by reducing inflammation in the intestinal lining. They don’t increase the risk of infection or cancer the way that some medications do. However, they’re more effective for colitis and don’t work as well as a stand-alone treatment for Crohn’s.
They’re generally safe, although you shouldn’t use them if you have kidney problems.
Moderate to severe Crohn’s can be treated with steroids to suppress the immune system. They work by mimicking cortisol, a substance naturally produced by your body to fight inflammation.
Steroids shouldn’t be used for a long period of time, since you can become dependent on or resistant to them. If you become dependent, you may not be able to stop using them without experiencing a flare.
If that happens, your doctor will help transition you to another type of medication so you can stop using the steroids.
These immune modifiers work by suppressing your immune system so it’s less responsive and less likely to cause chronic inflammation. This is the same medication given to organ transplant recipients so their bodies won’t reject new organs.
It’s also useful for Crohn’s treatment by helping you to transition off steroid medication.
Immunomodulators put you at increased risk for infection, and they can have adverse effects on blood pressure and kidney functions. Certain immunomodulators shouldn’t be taken during pregnancy.
Crohn’s disease isn’t curable but there are several treatment options available. The goal of treatment is to reduce inflammation and to put the disease in remission.
Biologics are very effective for achieving remission but also have side effects. Your doctor will help you decide if and how soon you should try biologics.