If you have Crohn’s disease, you may go through a variety of treatments before you find one that effectively manages your symptoms.
Treatment for Crohn’s disease often targets the immune system. This involves drugs that modify the way your immune system reacts to what’s perceived as a threat. By doing so, these medications can reduce inflammation and symptoms of Crohn’s.
TNF-alpha inhibitors are known as biologic therapies. TNF stands for “tumor necrosis factor.”
Biologics are powerful therapies in Crohn’s disease. They can also have very serious side effects. They’re usually prescribed for people with moderate to severe Crohn’s symptoms or if other treatments haven’t worked.
Biologics are medications made from living cells that work to block the immune system’s natural response to antigens, or something your body perceives as harmful.
In people with Crohn’s disease, the body’s immune system can’t tell the difference between foreign substances and the body’s own tissue. This causes the inflammation that creates so many symptoms.
Biologic therapies, unlike other treatments for Crohn’s disease, aggressively target particular proteins that cause inflammation of the gastrointestinal tract. This often makes them successful when no other treatment has worked.
However, this aggressive therapy can compromise your health in other ways.
There are three types of biologics:
- TNF-alpha inhibitors
- integrin blockers
- interleukin blockers
Some people with Crohn’s disease are able to take a TNF-alpha inhibitor at home. These people are given prefilled pens or syringes with just the right amount of medicine. Your doctor gives you a dosage schedule, and you then administer treatment yourself.
TNF-alpha inhibitors block the immune response that causes Crohn’s disease symptoms. However, blocking this immune response can create new problems.
These drugs can’t solely block your immune system from attacking your own tissue while leaving your natural immune responses intact. This leaves you susceptible to other diseases and infections and can sometimes increase the risk of developing certain cancers.
You can have an increased risk of tuberculosis while on this medication. In addition to injections or intravenous treatments, you’ll also need regular skin tests to make sure you aren’t infected.
TNF-alpha inhibitors are expensive. Treatments can cost up to thousands of dollars.
Some of these medications require people to spend hours in the doctor’s office receiving treatment intravenously. This can also be time-consuming and costly if you need to take a lot of time off from work for treatment.
Natalizumab (Tysabri) and vedolizumab (Entyvio) are integrin blockers. These medications work by interfering with the process of white blood cells attaching to the lining of the intestines. This reduces inflammation and relieves other symptoms.
Some severe, even fatal, side effects have been associated with integrin blockers. Their benefits in treating Crohn’s disease should be weighed against the side effects and benefits of TNF-alpha inhibitors when making treatment decisions.
Before being able to take natalizumab, you must be enrolled in a program called TOUCH. The TOUCH prescribing program is the only way you can receive Tysabri.
The prescribing program requirement is due to the risk of a rare but deadly brain disorder that has been connected with natalizumab. The disorder is called progressive multifocal leukoencephalopathy (PML). It’s an inflammation of the white matter of the brain.
Vedolizumab doesn’t appear to have the same risk of PML that natalizumab does, even though both drugs work in similar ways.
The third class of biologics used to treat Crohn’s is the interleukin inhibitors. Ustekinumab (Stelara) is the only drug in this class that’s been FDA-approved.
Ustekinumab targets two specific proteins that are thought to cause inflammation: interleukin-12 (IL-12) and interleukin-23 (IL-23). People with Crohn’s have higher levels of IL-12 and IL-23 in their body.
By targeting these proteins, ustekinumab blocks inflammation in the GI tract and decreases symptoms of Crohn’s disease.
Ustekinumab is used to treat adults with moderate to severe Crohn’s who haven’t responded well enough to conventional therapy. It’s initially given intravenously under the supervision of a healthcare professional.
Following doses of ustekinumab can be given via an injection under the skin every eight weeks, by either a healthcare provider or patients themselves after they’ve received training.
Like other biologics, ustekinumab can increase the risk of infections.
Your doctor may prescribe biologic therapies if you have moderate to severe Crohn’s disease or if other treatments haven’t worked for you. Make sure to ask about and fully understand the possible side effects of all medications your doctor prescribes for you.