In 1932, Dr. Burrill Crohn and two colleagues presented a paper to the American Medical Association describing the details of what we now call Crohn’s disease.
Since then, treatment options have evolved to include biologics, which are drugs made from living cells that are designed to target inflammation.
Inflammation is the core cause of Crohn’s disease symptoms and complications. When you’re in remission, your inflammation fades. When you’re experiencing a Crohn’s flare, your inflammation returns.
While there is no cure for Crohn’s, the goal of treatment is to reduce inflammation to put the disease into remission, and to keep it there.
Tumor necrosis factor, or TNF, is a protein that induces inflammation as part of an immune system response. Anti-TNF biologics work by targeting this protein to reduce its inflammatory properties.
If you take Remicade (infliximab), Humira (adalimumab), Cimzia (certolizumab), or Simponi (golimumab), you’re taking an anti-TNF biologic.
With Crohn’s disease, your immune system sends too many white blood cells to the gastrointestinal (GI) tract, which triggers inflammation. Another way that biologics target inflammation is by addressing the issue of having too many white blood cells in the GI tract.
Entyvio (vedolizumab) and Tysabri (natalizumab) work this way. They stop white blood cells from entering the stomach. This blocking action keeps the white blood cells away from the gut, where they would otherwise cause inflammation. In turn, this allows the area to heal.
Biologics can target other pathways in the body that lead to inflammation. Stelara (ustekinumab) is an interleukin inhibitor. It targets two specific proteins that are thought to cause inflammation. People with Crohn’s have higher levels of these proteins in their body.
By targeting these proteins, Stelara blocks inflammation in the GI tract and decreases symptoms of Crohn’s disease.
It’s normal to have good days and bad days when you have Crohn’s, so how do you know if you’re in remission and not just having several good days?
There are two aspects to remission. Clinical remission means you have no noticeable symptoms. Tissue remission means that tests indicate your lesions are healing and your blood has normal inflammation levels.
Your doctor uses something called the Crohn’s disease activity index (CDAI) to measure the degree to which your Crohn’s is active or in remission. The CDAI takes into account your symptoms, like number of bowel movements and how you are feeling.
It also takes into account the complications of Crohn’s disease and results of your tests.
Even while you’re in remission, it’s common for a biopsy to show microscopic changes to your tissue that indicate previous inflammation. Sometimes, in the case of prolonged and deep remission, biopsy results are normal, but this is not usually the case.
Biologics keep you in remission by blocking your immune system’s overactive inflammation response. If you go off your medication while in remission, you’re more at risk for reacting to a trigger with a flare.
Sometimes triggers can be hard to predict. Others, such as the following, are easier to identify:
- dietary changes
- cigarette smoking
- medication changes
- air pollution
If you are on medication while exposed to triggers, your Crohn’s disease is less likely to be activated.
Biosimilars are later versions of biologics with very similar structure, safety, and effectiveness. They’re not generic versions of the original biologics. Instead, they’re copies of original biologics whose patents have expired.
They generally cost less and are also effective for maintaining remission.
Once you’re in remission, you may be tempted to stop treatment. If you do, you risk experiencing a new flare.
If you stop taking your medication, there’s a possibility that it may not work as well the next time you have a flare. This is because when you stop taking a biologic, your body can grow antibodies against the drug, which makes it less effective in the future.
It could even lead to adverse reactions.
Biologics suppress your immune system, which puts you at risk for infection. Because of this, there are certain situations where your doctor may advise you to take a medication break. These include:
Otherwise, the recommended practice is to stay on the medication even when you are in remission.
Studies have shown that only about half of people who stop using their anti-TNF biologic while in remission actually stay in remission for longer than two years, and that number decreases with time.
The goal for your Crohn’s treatment is to obtain and sustain remission. Missed medication can lead to flares. It’s important to work with your doctor to establish the best strategy for staying in remission. This includes having regular checkups and maintaining your medication regimen.