What treatment do you start with?

[Jessrich18]

I was wondering what treatment do you start with when your newly diagnosed with crohns, can it depend on how sever the symptoms and inflammation is?

Jess.

 

[shamrock15]

I think it is pretty common that most people are diagnosed while in flare, and you almost always are started on pred. I am not sure if that has changed at all recently, but pred is at least normally quite effective early on in getting inflammation down. Depending on severity, you may move onto other maintenance meds, you may need surgery, or if you are fortunate, you could go into remission and never need another med. Lots of possibilities are out there. Are you in the process of being diagnosed?

 

[alex_chris]

Hey Jess,

Yes, it very much depends on your symptoms, your history until your diagnosis and at the end also your tolerance of certain drugs. The standard treatments have also changed very much over the years. I'll give a brief overview:

1. 5-Asa/mesalazine: This was used in the past as the first option for long-term Crohn's treatment. It is a rather insufficient drug that has helped some patients, but not many. More and more doctors ignore 5-Asa and don't prescribe it, even if the patient just has few if any symptoms.

2. Azathioprine/6mp (immunosuppresives): The standard treatment since the 90s and before biologics were approved. It takes a while for those meds to kick in, they help up to 30-40% of patients to stay in remission. They can have various side effects, but for most patients and doctors the benefits outweight the potential problems.

3. Biologics (remicade, humira, cimzia): The standard treatment since about 10 years for most moderate-severe patients and in the last few years also the standard treatment for all newly diagnosed patients with just mild to moderate Crohn's. Helps 50% of patients to go and stay in remission. Is a bit more problematic than aza/6mp, but still benefits outweigh the risks.

4. Biologics/immunosuppresives combination: Recent studies show this is the most effective treatment with over 60% of patients going into remission and staying there - although it is probably the most invasive treatment version.

5. Prednisone / Budesonide: Those are corticosteroids which are used short term (a few weeks) to fight inflammation. Dangerous in the long-term (thinning out of tissue and various other side effects). In the past (up until the 90s) this was the first treatment option.

One problem today is that it very much depends on which GI you find what meds they prescribe. Some GIs are stuck in the past and will desribe nothing at all or 5-Asa, some GIs will go straight for biologics without considering biologics or immunosuppresives combination, some will also even go over the top and have you on a strong dosage of pred longer term. Some want to get you on aza or 6mp first before trying biologics (specifcally US insurance company want that because biologics are expensive...).

But to sum up a few facts:

1. Biologics/immunosuppresive combination is the most effective way to treat Crohn's today. There are concerns about doing that long-term though - but nobody really has any real long-term data.

2. Either biologics or immunosuppresives alone can get you into remission. Of course only if you also do your non-med Crohn's management. Most people are on either one of those.

3. Steroids are bad. That's just a fact. Unfortunately in many situations they are also unavoidable, specifically to treat severe flare ups.

I hope that helps a bit. There are many threads dealing with medication that go into more details.

 

[AlexJ]

I was diagnosed whilst in a flare and started on a 40mg pred taper, azathioprine and pentasa. I'd expect the majority of people to have a similar experience.

In my case I could never get off pred and after a year of messing around with a host of different medicines (infliximab, budesonide, 6mp...) surgery became my only option.

 

[Jessrich18]

Thank you all for answering, you've really helped. shamrock15, yes i am in the process, ive had all the tests, the docs found, inflammtion on the right side of my large bowel, erythema in the ileum and ceacum and the blood tests showed my vitamin B12 levels are low. Now i'm just waiting for the MRI small bowel results. I see my doctor in july so hopefully i'll find out then. Bit worried if i am to be put on steriods, the side effects dont sound appealing to me. Fingers crossed i will be put on something else!

Jess

 

[alex_chris]

Jess, just to clarify on the steroids: they are the best short term medication there is and any side effects of them are not really a problem considering the potential benefit of getting your inflammation under control. So I did not want to alarm you at all.

What I tried to say is that many, many years ago, steroids were the only thing docs had to help. So, what they did is prescribe them excessively over many years. And that can have long-term problems. But again, short-term to get your current inflammation under control they are the first choice.

Hope all will go well for you.

 

[smiley95]

Hi Jessrich18,

I actually started on Aza, but could not tolerate it, so went to 6 mp. I was never given Prednisone. I think it depends on your individual case and your Dr.

Prayerfully, you find the perfect meds for you right away!

 

[Sailorluna]

I was diagnosed on the operating table after a blockage was removed. They started me on aza then later added humira which has since been replaced with Cimzia. Pred was added last year at a low dose for my joint issues.

 

[kiny]

I was started with neck feeding and stayed in the hospital for a month, that was my treatment, they didn't use medication. It's called total parental nutrition in the US or something.

After that month I got pentasa.

Pentasa and feeding is a standard treatment here if you have crohn's disease. Steroids are rare, and if they do use them it's almost always entocort.

 

[hawkeye]

For me prednisone was first then 5-ASA and aza, with bowel rest and an elemental diet between the 5-ASA and aza to get things under control . This was in the early 90's before the days of Humira and Remicade