Biologics are one of many options for treating the inflammation caused by Crohn’s disease. Three types target different parts of the body’s inflammatory response.
Crohn’s disease involves chronic intestinal tract inflammation. It interferes with food digestion, nutrient absorption, and waste elimination. Crohn’s is one of the main forms of irritable bowel disease (IBD).
There’s no cure for Crohn’s, but the right treatment can manage symptoms and maintain remission.
Medical treatment for Crohn’s includes conventional medications and biologics. Biologics are effective at putting Crohn’s into remission and keeping it there. However, these treatments can increase the risk of infection and certain cancers.
Treatments for Crohn’s disease have evolved to include medications called biologics, which are made from living cells. Examples of biologics used to treat Crohn’s include:
- adalimumab (Humira)
- ustekinumab (Stelara)
- infliximab (Remicade, Inflectra, Renflexis)
- golimumab (Simponi)
- vedolizumab (Entyvio)
They are typically administered:
- intravenously (IV)
- intramuscularly, or injected into muscle
- subcutaneously, or injected into the skin
Biologics target the inflammation process. They are designed to treat moderate to severe Crohn’s and are often the next step in treatment if 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.
This can include altering inflammatory signals or stopping cells from going to inflammation sites in the gut, which allows the gut to heal.
There are three types of biologics that work in different ways:
- Anti-TNF: These biologics target the inflammation-causing protein tumor necrosis factor (TNF) and maintain remission.
- Integrin blockers: Also known as selective adhesion molecule (SAM) inhibitors, integrin blockers stop inflammation-causing cells from finding vulnerable areas in the gut so it has time to heal.
- Antibody to the p40 subunit of IL-12 and IL-23: These biologics stop IL-12 and IL-23, which are both pro-inflammatory proteins your cells produce. Blocking IL-12 and IL-23 signals reduces inflammation and causes remission.
Biologics have been traditionally used as part of a step-up approach when other treatments do not produce desired results.
Guidelines now support choosing an appropriate therapy based on your outlook. This means that, in people with significant disease, biologics can be given right away and may prevent some damage before it starts.
However, some biologics can increase your risk of infection and cancer.
It’s important to adhere to your treatment, including your prescribed dosage. Stopping or inconsistently following your treatment can cause biologics to lose their effectiveness.
Biosimilars are copies of biologics with expired licenses, similar to how some brand-name drugs have generic versions.
Because these drugs are made from biological materials and are very complex, they’re not identical to the originals. However, they’re similar enough in structure and function to be safe and to work well — and they’re more cost effective.
Talk with your doctor if you’re thinking of switching from biologics to biosimilars.
Antibiotics are used to treat infections caused by Crohn’s disease. They can also help symptoms by reducing the number of bacteria in the intestines.
Common antibiotics for Crohn’s disease are:
- metronidazole
- ampicillin
- ciprofloxacin
Antibiotics can help get rid of the bacterium Clostridium difficile. People with IBD are prone to C. diff.
C. diff is responsible for symptoms like:
- diarrhea
- vomiting
- fever
- abdominal pain
- cramping
- bloody stools
Be sure to take antibiotics as prescribed by your doctor. Doing so helps prevent antibiotic resistance.
Aminosalicylates, specifically 5-aminosalicylic acid (5-ASA), help treat mild to moderate inflammatory Crohn’s by reducing inflammation in the intestinal lining.
Examples include:
- sulfasalazine (Azulfidine)
- olsalazine (Dipentum)
- balsalazide (Colazal)
Administration for some 5-ASAs is oral, while others might be rectal.
They don’t increase the risk of infection or cancer the way that some medications do. However, 5-ASAs are more effective for colitis and don’t work as well as a stand-alone treatment for Crohn’s.
According to the Crohn’s and Colitis Foundation, 5-ASAs must be used at the same time as other therapies to control inflammation and prevent complications.
Aminosalicylates are helpful for controlling mild inflammation and symptoms when used for Crohn’s but are minimally used as a treatment.
They’re generally safe, although they are not recommended if you have kidney problems.
Take this medication only as prescribed by your doctor.
Corticosteroids, or “steroids” for short, suppress the immune system and can treat moderate to severe Crohn’s disease. They work by mimicking cortisol, a substance the body naturally produces to fight inflammation, and by lowering the activity of the immune system.
Options for administration of corticosteroids include:
- orally
- rectally (through the rectum)
- by injection
Formulations for corticosteroids include:
- oral tablets or capsules:
- prednisone (Deltasone)
- budesonide (Entocort EC)
- budesonide-MMX (Uceris)
- enemas:
- hydrocortisone (Cortenema)
- methylprednisolone
- rectal foam:
- hydrocortisone acetate and pramoxine hydrochloride (Proctofoam-HC)
- budesonide (Uceris)
Corticosteroids aren’t intended to be taken for a long period of time because of the high risk of dependence. It’s also possible to develop a resistance to them.
You may not be able to stop using them without experiencing a flare if a dependence develops. If this happens, your doctor will help transition you to another type of medication so you can stop using the steroids.
Immune modifiers, or immunomodulators, work by suppressing the immune system, making it less responsive and less likely to cause chronic inflammation. The same medication is given to organ transplant recipients so their bodies won’t reject new organs.
Examples include:
- azathioprine
- 6-mercaptopurine
- cyclosporine
- tacrolimus
Immunomodulators are useful for Crohn’s when treatment with corticosteroids or aminosalicylates has not been effective or only partially effective.
Immunomodulators can increase the risk of infection. They can have adverse effects on blood pressure and kidney functioning.
Certain immunomodulators are avoided during pregnancy.
They may also take several months to work.
Crohn’s disease isn’t curable, but several treatment options are available. The goal of treatment is to reduce inflammation and 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.
If you’ve tried biologics and they didn’t work, you have other options to treat your Crohn’s disease, including aminosalicylates, corticosteroids, or immunomodulatory drugs.
It’s important to stick to your treatment plan, as discussed with your doctor, to get the best results.