What kinds of drugs are used to treat Crohn's disease?
There are several types of drugs used to treat Crohn's disease. The first step usually involves reducing inflammation. Many people are first treated with sulfasalazine (Azulfidine). Mesalamine (Asacol, Canasa, Pentasa) is another 5-aminosalicylic acid, or 5-ASA medication. Possible side effects of sulfasalazine and other mesalamine-containing drugs may include:
nausea
vomiting
diarrhea
heartburn
headache
If a person does not respond to sulfasalazine, the doctor may prescribe other types of drugs that contain 5-ASA. These other products include:
olsalazine (Dipentum)
balsalazide (Colazal, Giazol)
mesalamine (Asacol, Lialda, Pentasa, and others)
Corticosteroids such as prednisone are another class of drugs that reduce inflammation. A doctor is likely to prescribe an initial large dose of prednisone when the disease is very active. The dose is then tapered off. A problem with corticosteroids is the large number of possible side effects -- some of them serious -- such as a higher susceptibility to infection and stomach ulcers.
Crohn's disease may also be treated with drugs that stop the immune system from causing inflammation. Immunomodulators change the way the immune system behaves. Immunosuppressants decrease the activity of the immune system. Immunostimulators increase the activity. Immunosuppressants prescribed for Crohn's disease include:
azathioprine ( Azasan, Imuran)
cyclosporine
6-mercaptopurine (6MP, Purinethol)
tacrolimus (Prograf)
Methotrexate (MTX, Rheumatrex, Trexall)
Side effects of immunosuppressants may include:
diarrhea
higher susceptibility to infection
nausea
vomiting
Biologic drugs such as infliximab (Remicade) or infliximab-dyyb (Inflectra), a biosimilar to Remicade, are often prescribed when a person with Crohn's disease does not respond to the standard treatments of 5 ASA-containing drugs, corticosteroids, and immunosuppressants. Infliximab is an antibody that attaches itself to the inflammation-promoting protein, tumor-necrosis factor-alpha (TNF-alpha). Other anti-TNF medications are adalimumab (Humira) and adalimumab-atto (Amjevita), a biosimilar to Humira. These drugs are also used to treat other immune system disorders such as rheumatoid arthritis. Certolizumab (Cimzia) is another anti-TNF blocker approved for Crohn's disease.
There are other biologic alternatives to the anti-TNF blockers. Two drugs block alpha-4 integrin -- natalizumab (Tysabri) and vedolizumab (Entyvio). Ustekinumab (Stelara) works in another way by targeting other proteins, IL-12 and IL-23.
Other substances that may be prescribed to treat Crohn's include:
Antibiotics to treat bacterial infections and overgrowth of bacteria in the small intestine; types of antibiotics commonly prescribed include:
ampicillin (Omnipen)
cephalosporins
fluoroquinolones (Ciprofloxacin)
metronidazole (Flagyl)
sulfonamides
tetracycline
Antidiarrheal agents to stop diarrhea
Fluid replacements to counteract dehydration
Nutritional supplements to provide the nutrients that may not be absorbing properly
