Multiple treatments are available to manage Crohn’s disease. Researchers continue to develop and test new treatments that may become available.
Crohn’s disease is a type of inflammatory bowel disease (IBD) that causes inflammation in the gastrointestinal (GI) tract. Scientists estimate it affects more than
Treatment for Crohn’s disease may include a combination of lifestyle strategies, medications, and, in some cases, surgery.
A treatment that works well for one person may not work well for another. Someone may need to try more than one treatment to find what works.
Medical News Today (MNT) spoke with two board certified gastroenterologists to learn more about the current treatment options for Crohn’s disease.
Jana Al Hashash, MD, MSc, is the American Gastroenterological Association Clinical Practice Update Committee chair-elect, and Arun Swaminath, MD, is chief of the gastroenterology division at Northwell Health’s Lenox Hill Hospital in New York City.
Doctors consider many factors when deciding which treatments to prescribe for Crohn’s disease.
“There are several classes of medications that are used to manage Crohn’s disease. The choice of therapy depends on disease severity, extent, presence of perianal disease, and/or presence of extraintestinal manifestations,” Al Hashash told MNT.
Perianal disease affects the area around the anus. Extraintestinal manifestations affect areas outside the intestines, such as the joints, eyes, or skin.
“We also consider a patient’s underlying comorbid conditions as we make decisions about which treatment to select for our patients,” said Al Hashah. For example, some medications may be safer than others for people who have chronic heart disease.
Someone’s treatment preferences, insurance coverage, and other factors may also affect their treatment.
“Shared decision making between the patient and the physician is critical in the management of chronic conditions such as Crohn’s disease,” said Al Hashash.
Each treatment carries different risks. A person’s doctor can help them weigh the potential benefits and risks of different treatments.
Multiple medications are available to reduce inflammation and symptoms of Crohn’s disease. They are listed below.
Lifestyle strategies and sometimes surgery may also be necessary to manage inflammation, symptoms, or complications.
Conventional drugs
A doctor may prescribe one or more of the following conventional drugs for Crohn’s disease:
- immunomodulators, such as:
- 6-mercaptopurine
- cyclosporine
- methotrexate
- sulfasalazine
Corticosteroids were a common treatment for Crohn’s disease before other medications became available. However, long-term use of steroids carries a high risk of side effects.
Doctors now try to limit steroid use for managing Crohn’s disease, but sometimes short-term treatment with steroids is necessary.
“We still sometimes use steroids to bridge between therapies or get a patient through a flare, but we try to prescribe the lowest amount for the least amount of time,” Swaminath told MNT.
“Having to take steroids over and over again or taking them for a long time may be a sign that you’re not on the right therapy,” he added.
Biologics and biosimilars
Biologics for Crohn’s disease are antibodies that help block the action of certain proteins that drive inflammation. A biosimilar has a very similar structure to an original biologic but is often less expensive.
The Food and Drug Administration (FDA) has approved the following biologics and biosimilars for treating moderate to severe Crohn’s disease:
- tumor necrosis factor-alpha (TNF-a) inhibitors:
- adalimumab (Humira)
- certolizumab pegol (Cimzia)
- infliximab (Remicade)
- infliximab-dyyb (Inflectra)
- anti-integrin drugs:
- natalizumab (Tsybari)
- vedolizumab (Entyvio)
- IL-12/23 inhibitor:
- ustekinumab (Stelara)
- IL-23 inhibitor:
- risankizumab-rzaa (Skyrizi)
Biologics tend to be more effective than conventional drugs alone for treating moderate to severe Crohn’s disease. Sometimes, a doctor may prescribe a biologic with a conventional drug.
If a person tries a biologic that does not work well for them, their doctor may prescribe a different type of biologic or another treatment.
For example, a
Janus kinase inhibitors
Janus kinase (JAK) inhibitors block the action of certain enzymes that help drive inflammation.
The FDA has approved upadacitinib (Rinvoq) for treating moderate to severe Crohn’s disease in people who have not experienced adequate or lasting improvements after treatment with a TNF-a inhibitor.
This JAK inhibitor is the first oral medication the FDA approved for Crohn’s disease.
Experimental treatments
Researchers are continuing to develop and test new medications in clinical trials. These new medications may help reduce inflammation and symptoms in Crohn’s disease while limiting side effects.
Examples of these new medications include new types of biologics, JAK inhibitors, and a class of medications known as sphingosine 1-phosphate receptor (S1P1) modulators.
The FDA has already approved some of these medications for treating ulcerative colitis, which is another type of IBD.
Researchers are also exploring the potential benefits and risks of combining existing treatments.
A person’s doctor might encourage them to participate in a clinical trial if other treatments have not worked well for them. Clinical trial treatments may carry risks that researchers have not yet identified.
The treatment goal for Crohn’s disease is to induce and maintain remission. This happens when the disease is no longer active and inflammation and symptoms are well managed.
“The first step is clinical remission, which happens when the patient feels well. The symptoms they were experiencing, whether it’s bleeding, diarrhea, weight loss, inability to tolerate different foods — that all needs to go back to normal,” Swaminath said.
“The second step is called endoscopic remission. You do a colonoscopy and see that the inflammation that was there before is almost gone or totally gone,” he continued.
A person’s doctor may order blood and stool tests, imaging tests, or endoscopic exams, such as colonoscopy, to monitor signs of inflammation. They may also order tests to check for potential treatment side effects.
“Not 100% of people are going to be able to achieve remission, but that should generally be the goal. You keep reassessing until you get there,” Swaminath said.
A person may need to take a new medication for several weeks or longer to learn whether it works well for them. Their doctor can help them learn how quickly the medication is likely to work. Some medications may take longer than others to have noticeable effects.
Sometimes, a medication may not improve inflammation or symptoms enough.
For example, the authors of the 2022 study mentioned above report that
To determine whether a medication works, people need to take it as their doctor prescribes. Their doctor may need to adjust the dosage to make it more effective.
“If a patient tries a medication and that does not work, we first need to make sure that the patient is getting enough of the medication, especially if the medicine is an anti-TNF agent,” said Al Hashash.
If the person still has active Crohn’s disease, their doctor may recommend changing medications.
Their doctor will also consider other health conditions or complications that might be causing their symptoms.
“It is important to exclude other reasons that could contribute to ongoing symptoms, such as an infection, concomitant irritable bowel syndrome, or a possible complication from the Crohn’s disease,” said Al Hashash. These conditions may require different treatments to manage.
Treatment is important for reducing inflammation, symptoms, and the risk of complications from Crohn’s disease. Multiple treatments are available. A person living with IBD may need to try more than one to find what works.
Swaminath encourages people with Crohn’s disease to speak with a GI doctor to learn more about the potential benefits and risks of different treatments.
In particular, people with moderate to severe Crohn’s disease may benefit from working with a GI specialist who has experience prescribing different treatments.
“In the last 20 years, a huge number of medications have become available. Some of them overlap in the ways they work, and some brands are new in their mechanisms of action,” said Swaminath.
“I think one of the biggest challenges is matching the treatment with the patient. I think the patient needs to be comfortable with the treating physician, and the treating physician needs to feel comfortable with the complexities of the patient to help them make good treatment decisions,” he added.
Swaminath also recommends resources from the Crohn’s & Colitis Foundation to learn more about treatments. He notes the organization may not have information immediately available about the newest treatments.