Researchers are looking for new ways to treat Crohn’s disease symptoms, as well as possible cures. Newer treatments are using medications that block inflammation at the source, rather than after the inflammation has occurred.

Researchers are also trying to uncover treatments that are more specific to the intestinal tract. Here, we take a look at drugs in the pipeline that may be effective at treating or even preventing or curing Crohn's. Also, we review the existing treatments available.

RHB-104 is one of the promising new drugs in the pipeline. Some 2016 research suggests that an infection with a bacteria called Mycobacterium avium paratuberculosis (MAP) may contribute to Crohn’s disease as well as other human diseases.

Studies are ongoing to uncover the exact role of the MAP bacteria in Crohn’s disease, as not all researchers agree. It seems that only some patients with Crohn’s disease are infected with MAP and some people infected with MAP do not have Crohn’s disease.

The bacterium causes serious intestinal infections in cattle, similar to Crohn’s disease in humans. As a result of this knowledge, several studies are underway to see if antibiotics that treat MAP help people with Crohn's disease.

The first clinical trial of RHB-104, an antibiotic cocktail of clarithromycin, rifabutin, and clofazimine, was completed in the summer of 2018. Results aren't yet published.

Researchers found that 44 percent of people with Crohn’s disease who took RHB-104, along with their existing medications, had a significant decrease in symptoms after 26 weeks. In the placebo group, 31 percent had a similar decrease.

At one year, the rates were 25 percent and 12 percent for the two groups, respectively.

While the results are promising, more studies are needed. The study didn't identify which patients were infected with MAP. Also, it’s not clear whether RHB-104 helps people achieve remission, or how the drug compares to other medications used for Crohn’s.

A year-long study conducted between 2018 and 2019 in the United Kingdom was designed to study the safety of an anti-MAP vaccine for humans. A total of 28 volunteers were recruited from Oxford, England.

The protocol involves two different vaccines and various doses of each. Only after safety is established can researches do a randomized trial on effectiveness. If it is, in fact, deemed effective, it could be 5 to 10 years before it becomes available.

Currently, there’s no known cure for Crohn’s disease. Treatment for the condition traditionally focuses on reducing symptoms. It also is sometimes effective at bringing a person’s Crohn’s disease into long-term remission.

Most of the time, Crohn’s is treated with medications. The first-line approach to reducing Crohn’s symptoms is to reduce inflammation in the bowel. In some cases, doctors will recommend surgery to help ease symptoms.

One or more of the following treatments are usually used:

  • anti-inflammatory drugs
  • immune system suppressors to reduce bowel inflammation
  • antibiotics to help heal ulcers and fistulas, and to reduce the amount of harmful bacteria in the intestines
  • fiber supplements
  • pain relievers
  • iron, calcium, and vitamin D supplements
  • vitamin B-12 shots to help reduce risks of malnutrition
  • nutritional therapy, such as a special diet plan or liquid diet to help reduce risk of malnutrition
  • surgery to remove damaged parts of the digestive system for symptom relief

Anti-inflammatory drugs

Corticosteroids, such as prednisone, have long been beneficial for people with Crohn’s disease. However, they are limited to short-term use when other treatments aren’t effective. This is because they can have many serious side effects on the entire body.

A 2012 review of studies suggests that more recently developed corticosteroids, such as budesonide and beclomethasone dipropionate, may be more effective at reducing symptoms, with fewer side effects.

Immune system suppressors

Common immune system suppressors that have been traditionally used to treat Crohn’s disease are azathioprine (Imuran) and mercaptopurine (Purinethol). But research has found that they can cause side effects, including increased risk of infection.

Another drug in this category is methotrexate, Typically, it's used in addition to other medications. All of the immune system suppressor drugs require regular blood tests to monitor potential side effects.

Biologics

Newer drugs, called biologics, are used in people with moderate to severe cases of Crohn’s disease. Depending on an individual’s overall health, not everyone may be a candidate for these medications.

TNF inhibitors

TNF inhibitors work by blocking a protein that causes inflammation. Some examples include infliximab (Remicade), adalimumab (Humira), and certolizumab pegol (Cimzia). Researchers have also found that for some people, TNF inhibitors may become less effective over time.

Natalizumab (Tysabri) and vedolizumab (Entyvio)

These drugs are also used to treat people with moderate to severe Crohn’s disease who don’t respond well to other medications. They block inflammation in a different way than TNF inhibitors. Rather than blocking TNF, they block a substance called integrin.

They work by keeping inflammatory cells out of tissue. Natalizumab (Tysabri), however, carries a risk for a serious brain condition in certain people. It's recommended that people get tested for a specific virus before using this medication in order to reduce this risk.

Research from 2016 suggests that vedolizumab works similarly to natalizumab, but so far it does not have the same risk of brain disease. Vedonlizumab seems to work more specifically on the intestinal tract rather than the whole body.

Ustekinumab (Stelara)

Ustekinumab (Stelara) is the most recent biologic approved to treat Crohn’s. It’s used in the same way as other biologics, and 2016 research suggests that it may be helpful in treating Crohn’s disease when other medications don’t work.

This drug works by blocking certain pathways of inflammation. However, in rare instances it can also affect the brain.

As our understanding of Crohn’s disease continues to improve, we can expect more effective treatment options in the future.

Having a specialist in Crohn’s as part of your medical team is one way to ensure you are receiving accurate information about your disease, as well as keeping up to date on any new treatment options.