Medication used to treat the Disease
Because there is no cure for Crohn's disease, the goal of medical treatment is to suppress the inflammatory response. This step accomplishes two important goals: It allows the intestinal tissue to heal and it also relieves the symptoms of fever, diarrhea, and abdominal pain. Once the symptoms are brought under control (this is known as inducing remission), medical therapy is used to decrease the frequency of disease flares (this is known as maintaining remission, or maintenance).
Several groups of drugs are used to treat Crohn's disease today. They are:
Adalimumab (Humira®) is a synthetic (man-made) protein, similar to human protein that blocks tumor necrosis factor alpha (TNF- alpha), a protein in your body that can cause inflammation. It works by attaching to TNF-alpha and blocking its effects and thereby reducing the inflammation and relieving symptoms associated with Crohn's disease.
Adalimumab is taken by injection every other week. It can be administered at home by the patient or family member once instructed by a healthcare professional.
Another biologic therapy is Natalizumab (Tysabri®). It was approved by the FDA in January of 2008 for inducing and maintaining clinical response and remission in adult patients with moderately to severely active Crohn's disease with evidence of inflammation who have had an inadequate response to, or are unable to tolerate, conventional Crohn's disease therapies and inhibitors of TNF-alpha.
Natalizumab (Tysabri®) is an antibody thought to inhibit certain types of white blood cells that are involved in the inflammatory process. It is infused into a vein at a certified infusion center and usually given once every 4 weeks. It takes about 1 hour to receive the entire dose.
The latest biologic treatment approved on April of 2008 by the FDA is Certolizumab pegol (Cimzia®). It is the first and only PEGylated anti- TNFa (Tumor Necrosis Factor alpha) antibody indicated for reducing signs and symptoms of Crohn's disease and maintaining clinical response in adult patients with moderate to severe active disease who have an inadequate response to conventional therapy.
The antibody portion of the drug is combined with a special chemical called polyethelyene glycol (PEG), which delays its excretion from the body. Patients treated with Cimzia ® receive an injection every two weeks for the first three injections. Once benefit has been established, Cimzia® is usually given once every four weeks.
Several other biologic agents for both Crohn's disease and ulcerative colitis are being studied in clinical trials currently, but none are yet commercially available.
Several groups of drugs are used to treat Crohn's disease today. They are:
- Aminosalicylates (5-ASA): This class of anti-inflammatory drugs includes sulfasalazine and oral formulations of mesalamine, such as Asacol,® Colazal,.® Dipentum,® or Pentasa,® and 5-ASA drugs also may be administered rectally (Canasa® or Rowasa® ). These medications typically are used to treat mild to moderate symptoms.
- Corticosteroids: Prednisone and methylprednisolone are available orally and rectally. Corticosteroids nonspecifically suppress the immune system and are used to treat moderate to severely active Crohn's disease. (By "nonspecifically," we mean that these drugs do not target specific parts of the immune system that play a role in inflammation, but rather, that they suppress the entire immune response.) These drugs have significant short- and long-term side effects and should not be used as a maintenance medication. If you cannot come off steroids without suffering a relapse of your symptoms, your doctor may need to add some other medications to help manage your disease.
- Immune modifiers: Azathioprine (Imuran®), 6-MP (Purinethol®), and methotrexateImmune modifiers, sometimes called immunomodulators, are used to help decrease corticosteroid dosage and also to help heal fistulas. In addition, immune modifiers can help maintain disease remission.
- Antibiotics: metronidazole, ampicillin, ciprofloxacin, others.
- Biologic therapies. In August of 1998 the FDA approved infliximab (Remicade®), the first biologic therapy to treat inflammatory bowel disease. Infliximab (Remicade®) is indicated for moderately to severely active Crohn's disease and ulcerative colitis patients who have not responded adequately to conventional therapy. It is also approved for reducing the number of draining enterocutaneous fistulas.
Infliximab (Remicade®) is a chimeric (a hybrid consisting of 75 percent human, 25 percent mouse protein) monoclonal antibody. The antibody works by blocking the immune system's production of tumor necrosis factor-alpha (TNF-alpha). This is a cytokine (chemical) that intensifies inflammation. Infliximab is given by infusion.
Adalimumab (Humira®) is a synthetic (man-made) protein, similar to human protein that blocks tumor necrosis factor alpha (TNF- alpha), a protein in your body that can cause inflammation. It works by attaching to TNF-alpha and blocking its effects and thereby reducing the inflammation and relieving symptoms associated with Crohn's disease.
Adalimumab is taken by injection every other week. It can be administered at home by the patient or family member once instructed by a healthcare professional.
Another biologic therapy is Natalizumab (Tysabri®). It was approved by the FDA in January of 2008 for inducing and maintaining clinical response and remission in adult patients with moderately to severely active Crohn's disease with evidence of inflammation who have had an inadequate response to, or are unable to tolerate, conventional Crohn's disease therapies and inhibitors of TNF-alpha.
Natalizumab (Tysabri®) is an antibody thought to inhibit certain types of white blood cells that are involved in the inflammatory process. It is infused into a vein at a certified infusion center and usually given once every 4 weeks. It takes about 1 hour to receive the entire dose.
The latest biologic treatment approved on April of 2008 by the FDA is Certolizumab pegol (Cimzia®). It is the first and only PEGylated anti- TNFa (Tumor Necrosis Factor alpha) antibody indicated for reducing signs and symptoms of Crohn's disease and maintaining clinical response in adult patients with moderate to severe active disease who have an inadequate response to conventional therapy.
The antibody portion of the drug is combined with a special chemical called polyethelyene glycol (PEG), which delays its excretion from the body. Patients treated with Cimzia ® receive an injection every two weeks for the first three injections. Once benefit has been established, Cimzia® is usually given once every four weeks.
Several other biologic agents for both Crohn's disease and ulcerative colitis are being studied in clinical trials currently, but none are yet commercially available.