Additionally, since medications used to treat Crohn’s disease can be associated with certain risks and side effects, finding the right medication for you can take a few tries.
Getting Started on Crohn’s Medications
When you’re first diagnosed with Crohn’s disease, the medication your doctor prescribes will depend on several factors, including the severity of the disease. “The treatment intensity has to match the disease intensity,” says Alexander Levy, MD, a gastroenterologist at Tufts Medical Center in Boston. For people with aggressive Crohn’s disease, the first line of treatment is typically corticosteroids, such as prednisone (Deltasone) and methylprednisolone (Medrol). These drugs act quickly to suppress inflammation. However, corticosteroids suppress the entire immune system, have a number of side effects, and are not meant to be taken long term. Another class of medication to treat Crohn’s disease is biologics. These medications, which include Remicade (infliximab), Humira (adalimumab), and Stelara (ustekinumab), target specific proteins in the body that cause inflammation. Biologics can be used to treat moderate to severe Crohn’s. Sometimes biologic drugs are combined with medications called immunomodulators. These include mercaptopurine (Purinethol, Purixan) and methotrexate (Trexall). “Both of these drugs have been around for decades and can be used either as monotherapy, meaning on its own for maintenance, or can be used in combination with these biologics to have a synergistic benefit,” Dr. Levy says.
The Goal of Crohn’s Disease Treatment
When it comes to treating Crohn’s disease, experts say there are several goals. “Primarily, we want to return a person’s quality of life to allow them to achieve the goals that they were hoping for before they even were diagnosed, whether that’s being able to go to school or have a career, to have children, or whatever it may be,” Levy says. The first step down this path is clinical remission, meaning the patient feels better. “If their symptoms were diarrhea or bloody diarrhea or pain, does that get better? That’s what we’re looking for,” Levy says. The second goal is endoscopic remission. This means when a doctor checks your intestines through a scope and camera, there is no inflammation. While feeling better is certainly important, achieving endoscopic remission is the ultimate goal. “Somebody who has achieved endoscopic remission has a lower chance of having a subsequent flare compared to somebody who just has clinical remission,” Levy explains. Once endoscopic remission has been reached, the goal of treatment then becomes maintaining remission.
How to Know When You May Need to Switch Crohn’s Medication
When you discuss your treatment plan with your doctor, you will be informed how long it may take to see improvement of your symptoms, as well as any potential side effects of the medication. “Some drugs take longer to work than others, so it may take a few weeks, or it may take up to a couple of months before you see a benefit,” Levy says. As you undergo your treatment, your healthcare team will closely monitor your symptoms and watch for potential side effects or complications. “This will vary by patient, but we objectively assess them at regular intervals, in terms of their clinical status, how they’re feeling, and where their disease is,” says Jessica Philpott, MD, PhD, a gastroenterologist at Cleveland Clinic in Ohio. If your symptoms are not improving in the time period in which they are expected, your doctor may either up your dose or change your prescription to a new drug. If your symptoms have improved, your doctor will still want to know that your insides are healing. That’s why around the six-month mark, you will likely undergo imaging tests to see if your intestines are still inflamed. If you have not achieved endoscopic remission — even if you are feeling better — your drug therapy may need to be adjusted, Levy says. It’s also possible for medication to work initially and then stop working. “Unfortunately, this is not uncommon,” Dr. Philpott says. Your doctor will first rule out any other potential causes of a symptom flare-up, such as an infection or if medication doses have been missed. “We also look into if there are any new medications that may be causing GI symptoms,” Philpott says. “One of the worst players in this regard are NSAIDs, nonsteroidal anti-inflammatory drugs.” Once all other causes have been ruled out, it’s likely you’re experiencing what’s called a loss of response to therapy. “When that happens, it may be that the body starts to clear the medicines faster than it used to,” Philpott explains. Your doctor will work with you to adjust or change your therapy as needed.
Get the Most Out of Your Crohn’s Therapy
One of the most important ways you can optimize your Crohn’s treatment is to make sure you take it as directed. Philpott also recommends keeping a diary of your symptoms and the foods you consume to see if you can identify triggers. Share this information with your doctor, who can help monitor your symptoms and patterns. Finally, experts say it’s important to be your own advocate. “I think the more someone educates themself about their disease and their treatments, the more they can be a good advocate for themselves,” Philpott says. “No one expects you to be your own doctor, but the more you know, the more you can express to your providers what your goals are and better understand the risks and benefits of the treatment you’re on.”
