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The CD Treatment Puzzle: Where Do Biologics Fit?

Medically reviewed by Saurabh (Seth) Sethi, MD, MPH on January 22, 2018Written by Nancy Lovering on January 22, 2018
cd treatment puzzle

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 is 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, and produce and maintain remission.

Medicinal treatment for Crohn’s consists of conventional medications and biologics, which are made from living cells. Biologics are effective at putting Crohn’s into remission and keeping it there. But these treatments 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.

Antibiotics

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.

Aminosalicylates (5-ASAs)

These drugs help to 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, but they are more effective for colitis and don’t work as well as a stand-alone treatment for Crohn’s. They are generally safe, although you shouldn’t use them if you have kidney problems.

Corticosteroids (steroids)

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, or you can become dependent on or resistant to them. If you become dependent on steroids, you may not be able to stop using them without experiencing a flare. If that happens, you doctor will help transition you to another type of medication so you can stop using the steroids.

Immunomodulators

These immune modifiers work by suppressing your immune system so that it’s less responsive and less likely to cause chronic inflammation. This is the same medication given to organ transplant recipients so that their bodies won’t reject new organs. It’s also useful for Crohn’s treatment by helping enable 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 should not be taken during pregnancy.

Biologics

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 they’re 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 that some drugs 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 inhibitors (SAM) 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. More doctors are seeing the benefits of starting earlier as part of a “top-down” strategy, meaning that when biologics are given sooner they may prevent some damage before it starts.

Biosimilars

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 are similar enough to be safe and to work well, and they are more cost effective.

The takeaway

Crohn’s disease is not 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.

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