Crohn’s disease is a type of inflammatory bowel disease (IBD). It can affect any part of the digestive tract. Symptoms of Crohn’s include pain, cramping, diarrhea, blood in the stool, and fatigue.
It’s a chronic disease that has times when symptoms flare, followed by periods of remission. Medications are a big part of managing Crohn’s disease. They work by reducing the inflammation that causes symptoms.
The way Crohn’s disease is managed is likely to change over time. A medication may work for a while and then no longer be effective. Sometimes side effects will mean that a change in treatment is needed.
Your healthcare team will be able to help you make decisions about treatment options.
Here are some signs that your current treatment might need to change and some of your options.
Several medications are used for Crohn’s disease. Crohn’s is an autoimmune disease. This means the immune system attacks otherwise healthy parts of the digestive tract.
This causes damage, resulting in the symptoms of Crohn’s disease. Treatments for Crohn’s disease reduce the immune system’s response to lower symptoms and allow your body to start healing.
Some common treatments include:
- Aminosalicylates (5-ASA): These are typically used to reduce inflammation in mild cases.
- Corticosteroids: These lower the immune system’s activities to reduce symptoms. They’re usually used for moderate to severe cases. They work quickly but are only for short-term use.
- Immunomodulators: These reduce overall inflammation in the body but take weeks to months to work.
- Biologics: These are infused or injected medications that target specific immune actions. Biologics are often used only if other treatments aren’t not working.
The goal of treatment is to keep inflammation under control to keep you in remission. If symptoms return, it’s a sign that you could be in a flare.
Your doctor may order an endoscopy to look for areas of inflammation in your digestive tract. An endoscopy is a type of imaging test that uses a small camera attached to a flexible tube.
If you have been feeling well and symptoms return, consider if anything else has changed. Notice if anything with your diet or routine may have been different lately. Things like stress or sleep may also affect how you feel.
Sometimes medication doses can be increased. Other times, a new medication will be added or will replace something you currently take.
What happens if anti-inflammatory medications don’t work for Crohn’s disease?
For mild symptoms, aminosalicylates (5-ASA) are often the first medication used. These work for some people to keep symptoms well-managed. If these don’t work, corticosteroids may be the next treatment approach.
What happens if steroids don’t work for Crohn’s disease?
Corticosteroids are medications that suppress the whole immune system. They can be very effective but also have a lot of
Typically, corticosteroids are only used short-term to quickly bring down inflammation. They may be used with immunomodulators, which are also effective but take much longer to work.
Immunomodulators include azathioprine (Imuran, Azasan), 6-mercaptopurine (6-MP, Purinethol), and methotrexate. They may be added to aminosalicylates or corticosteroids.
Corticosteroids shouldn’t be used long-term. An immunomodulator may replace a corticosteroid for long-term use.
What happens if an immunomodulator doesn’t work for Crohn’s disease?
Thiopurines are a type of immunomodulator. The main thiopurine that’s used for Crohn’s disease is azathioprine (Azasan, Imuron). On their own, there is mixed evidence about whether they can bring on remission.
There are also concerns about intolerance. Up to 25% of patients using thiopurines had an adverse effect and had to stop the treatment.
Thiopurines and biologics often work together to induce remission. Biologics are another medication that works to reduce inflammation. They target specific proteins released by the immune system.
Blocking these immune proteins prevents them from reaching the digestive tract lining. This prevents them from causing damage.
What happens if biologics don’t work?
Biologics on their own don’t work for everyone.
Anti-tumor necrosis factor (anti-TNF) drugs are a type of biologic used for Crohn’s disease. They include adalimumab (Humira) and infliximab (Remicade).
It’s estimated that
In those cases, a different biologic may work. Switching to another biologic is
Combination therapies may work better to induce remission. A research study compared vedolizumab (Entyvio) on its own or with a thiopurine. It showed better outcomes with the combination in people with Crohn’s disease, but not ulcerative colitis.
Another biologic, infliximab (Remicade, and biosimilars Avsola, Inflectra, IXIFI, Renflexis), is shown to be more effective when combined with a thiopurine.
This can be a tough decision.
You may have been taking the same medications for years and have been kept in remission. It may feel overwhelming to change your treatment. The unknown of starting a new treatment can be another source of stress at an already stressful time.
The main reason to switch is if the treatment isn’t working to keep you in
Another reason to switch is if you’re experiencing a lot of side effects from your medication. Some side effects are to be expected and can lessen over time. Other side effects are more serious. Blood work may be necessary to watch for signs of intolerance with some medications.
It’s essential to have a good relationship with your healthcare team. You want to feel like your concerns and needs are heard. It’s important to feel informed about any medication changes.
Consider asking some of the following questions:
- How do I take this medication?
- Can the dose be adjusted if needed?
- How long does this medication take to start to work?
- What side effects should I watch for?
- How long will I stay on this medication?
- What is the follow-up plan?
Crohn’s disease is a chronic illness with periods of remission and symptom flares.
It’s common that treatments will need to change over time to induce or stay in remission. Several medications are used as part of managing Crohn’s disease.
In some cases, medication doses are increased. Other times, a new medication is added to the current plan or replaces another medication.
It can take time for medications to start working, sometimes weeks or months. Throughout the process, make sure to stay in touch with your healthcare team. It can be a challenging time, and it’s important to feel supported.