A Guide to Crohn's Disease Drugs
There is no cure for Crohn's disease, a type of inflammatory bowel disease. But there are many effective drugs that can treat the symptoms.
"There are a lot of sophisticated ways drugs are combined and for different purposes," says Arthur DeCross, MD, associate professor of medicine at the University of Rochester Medical Center in Rochester, New York.
Here are some 12 different types of drugs and how they can help make life easier for people with Crohn's.
Corticosteroids, usually prednisone, can provide rapid relief of pain and diarrhea. In general, these very effective medications aren't appropriate for long-term use because of side effects, such as bloating, excessive facial hair, sleep disruption and, even an increased risk of diabetes and osteoporosis.
Corticosteroids for Crohn's disease can be taken in pill form, rectally, or intravenously, and generally start working within days.
Entocort targets the ileum (the lower part of the small intestine) and the first part of the large intestine. But Entocort is not nearly as powerful as prednisone so it's not likely to be as helpful in people with severe Crohn's disease, says Dr. DeCross.
Azathioprine and mercaptopurine
These drugs are often slow-acting, with an average response time of about three months, says Dr. DeCross. "It also takes a lot of fussing and finesse to get the drug levels just right and monitor the body for adverse effects but, once you establish the dosage, they can be effective in the long-term," Dr. DeCross says. Side effects can include infections as well as nausea and vomiting, pancreatitis, and elevated liver function tests.
The good news? It comes in pill form and is relatively inexpensive. The bad news? It's a sulfa drug so anyone with a sulfa allergy needs to stay away from it. It can also have unpleasant side effects including nausea, vomiting, headache, and heartburn.
It comes in a pill form, enema (Rowasa), or suppository (Canasa).
Many doctors have stopped using mesalamine because the research has been mixed on its efficacy, says Nirmal Kaur, MD, medical director of the Inflammatory Bowel Disease Center at Henry Ford Health System in Detroit. "It has fallen out of favor."
Olsalazine (Dipentum) and balsalazide (Colazal), which are closely related to mesalamine, may represent other options.
Biologics work relatively rapidly (within a couple of weeks) but are usually used for more severe disease, or in those with bowel obstructions or fistulas (abnormal connections, including abscesses, between parts of the body), says Dr. Kaur.
Because these drugs suppress the immune system, they can have side effects, including a risk of serious infection. Remicade is given by intravenous infusion ever few weeks.
Humira is delivered by an initial injection followed by patient-administered self-injections every two weeks. People may experience pain and irritation at the site of the injection while more serious side effects can include a susceptibility to infections, such as tuberculosis or fungal infections.
The drug, which is given by intravenous infusion, tends to be reserved used for moderate-to-severe cases of Crohn's. It carries a heightened risk of infections, including multifocal leukoencephalopathy, a severe brain infection.
Because of this, people generally take it as part of a restricted program that includes monitoring.
"It's a great therapy that can be very effective in the right clinical settings," says Dr. Kaur. However, women of child-bearing age need to use birth control while taking it because it can cause birth defects.
Methotrexate, which is given by weekly injections or oral tablets, can also raise the risk of infections like some other Crohn's drugs.
"There's no harm in using an anti-diarrhea like Imodium [loperamide] or Lomotil [diphenoxylate] to bring additional symptom relief," says Dr. DeCross.