Medications for Crohn's disease—a chronic, progressive, and relapsing inflammatory bowel disease (IBD)—include a variety of conventional and newer prescription therapies.
These include drugs such as aminosalicylates, steroids, and antibiotics. Other novel treatments approved in recent years include biologics and immunosuppressants.All of these treatment options aim to decrease immune system activity to reduce inflammation.
The treatment of Crohn's disease depends on disease severity, risk factors, individual preference, age of onset, and medical complications.
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Types of Medications for Crohn's Disease
The treatment options for Crohn's disease have dramatically increased over the past two decades. Most medical therapies for managing Crohn's disease work by suppressing an overly active intestinal immune system.
Medication therapy for Crohn's has two goals:
- To induce clinical remission (relief of symptoms and mucosal healing of the colon's lining)
- To prevent a relapse of the disease while in remission
People with Crohn's disease often cycle through multiple therapies before finding an effective one.Common drugs for the treatment and management of symptoms include:
- Aminosalicylates
- Steroids
- Immunosuppressants
- Antibiotics
- Biologics
- A combination of immunosuppressant drugs and biologics
- Over-the-counter (OTC) medications for symptom management
Healthcare providers assess the advantages and disadvantages of each therapy to determine the right one.
Aminosalicylates
Aminosalicylate drugs are not specifically approved by the U.S. Food and Drug Administration (FDA) to treat Crohn’s disease. However, they are thought to treat Crohn's by reducing the inflammation of the intestines caused by the disease.
These drugs effectively treat mild-to-moderate episodes of the disease and are useful as a maintenance therapy. Aminosalicylates work best in the colon but are not very effective if the disease is limited to the small intestine.
Examples include:
- Azulfidine (sulfasalazine)
- Apriso (mesalamine)
- Dipentum (olsalazine)
- Colazal (balsalazide)
These medications can be taken orally or via the rectal route of administration.
Steroids
Corticosteroids, also called steroids, are similar to the adrenal glands' hormones, which reduce inflammation and affect the immune system. They reduce the activity of the immune system and decrease inflammation.
Corticosteroids are taken to treat moderate to severely active Crohn's disease. Due to their severe side effects, they are not recommended for long-term use or as maintenance therapy.
The common corticosteroids used include:
- Rayos (prednisone)
- Medrol (methylprednisolone)
- Uceris (budesonide)
- Hydrocortisone
These medications are available orally or via injection.
Immunosuppressants
Immunosuppressants reduce immune system activity, resulting in less inflammation in thedigestive tract. Immunomodulators can take several weeks to three months to start working.
These drugs are usually prescribed when aminosalicylates and corticosteroids haven’t been effective or have been only partially effective.
Immunosuppressants may also be useful in maintaining remission in people who haven’t responded to other medications.
Immunosuppressants include:
- Purinethol (6-mercaptopurine)
- Azasan (azathioprine)
- Gengraf (cyclosporine)
- Trexall (methotrexate)
Antibiotics
Gut microbes play a role in the progression and complications of Crohn’s disease. Antibiotics reduce the concentrations of bacteria in the gut lumen and control immune response to lower inflammation.
Antibiotics are also helpful to prevent or treat complications that involve infection, such as abscesses (swollen and pus-filled pockets caused by infection) and fistulas (abnormal gaps in areas around the rectum and anus).
Antibiotics help prevent the recurrence of the disease. However, they come with side effects, such as the development of antibiotic resistance.
Common antibiotics taken alone or in combination are:
- Cipro (ciprofloxacin)
- Flagyl (metronidazole)
- Xifaxan (rifaximin)
Biologics
Biologics are protein-based drugs made from living organisms, such as microorganisms, humans, or animal cells. These medications are antibodies that target the inflammation-causing proteins produced by the immune system. Neutralizing these proteins decreases inflammation in the intestines.
Biologic therapies help people gain relief from Crohn's disease symptoms, especially in people who do not respond to other medicines.
Common drugs used in biologic therapies include:
- Humira (adalimumab)
- Cimzia (certolizumab)
- Remicade (infliximab)
- Tysabri (natalizumab)
- Entyvio (vedolizumab)
- Stelara (ustekinumab)
Combination Therapy
In some cases, combination therapy for Crohn's disease can be more effective than monotherapy (only using one therapy at a time). It involves combining different types of drugs, such as biologic drugs, with immunomodulators.Drugs that work differently provide additional benefits.
Early studies suggested that combining infliximab and an immunomodulator drug such as azathioprine may improve outcomes such as colon healing and preventing symptom relapses.
Other Methods for Symptoms Management
Diet: Eat a well-balanced, healthy diet and avoid spicy and greasy food. Eat small portions that are high in fiber and drink plenty of water.
Stress reduction: Try to reduce stress by joining a support group or confiding in other social support systems. Stress can aggravate the Crohn's disease symptoms.
Bowel rest: Sometimes, you need to rest your bowel for a few days to several weeks to ease the symptoms. If your provider recommends bowel rest, they may have you consume only certain nutrient-rich liquids. You may also receive nutrients intravenously (IV).
OTC medications: Some OTC medicines can help relieve pain and inflammation. Tylenol (acetaminophen), a painkiller, can be helpful, while Imodium (loperamide) can treat diarrhea.
Avoid NSAIDs such as Advil (ibuprofen) or Naprosyn (naproxen), which can worsen inflammation and exacerbate your condition.
Foods for Crohn’s Disease Flare-Ups
A well-balanced, healthy diet, including enough calories, protein, and proper nutrients can help to avoid flare-ups. Avoid some foods that worsen the symptoms, such as diarrhea and gas. Some options include:
- Eating small amounts of food at a time
- Drinking lots of water
- Avoiding high-fiber foods
- Avoiding fatty, greasy, or fried foods and sauces
- Limiting dairy products
- Avoiding spicy foods
Summary
The treatment of Crohn's aims to relieve the symptoms and control the disease's relapses. The most common medications for treating Crohn's are aminosalicylates, corticosteroids, immunosuppressants, biologic agents, antimicrobials, and many newer-generation treatments.
All these drugs work to suppress the immune system and reduce inflammation in the gut.However, no single treatment works for everyone with Crohn's disease. The choice of drug depends on the individual's condition, symptoms, preferences, and responsiveness to treatment.
