You wouldn’t fight a forest fire with a garden hose, right? But for many years, that’s how doctors approached Crohn’s disease treatment, tamping down painful, debilitating symptoms before opting for advanced therapies that actually douse the spark—a hyperactive immune system.
More than 500,000 Americans are believed to have Crohn’s, a type of inflammatory bowel disease that counts diarrhea, nausea, cramping, anemia, fatigue, and joint pain among its day-to-day symptoms. The chronic condition can also produce swelling, blockages, and pockets of infection throughout the gastrointestinal (GI) tract as well as excruciating tunnels called fistulas that connect the intestine to other organs or tissues.
For patients with moderate to severe Crohn’s, frequent hospitalizations or surgery to remove damaged intestinal tissue are ever-present concerns. But new clinical guidelines from the American Gastroenterological Association (AGA) offer doctors an updated treatment strategy, recommending aggressive therapy sooner with a rapidly expanding group of medications called biologics that calm the immune system.
While these guidelines are new, this proactive approach to treating Crohn’s isn’t. It formalizes a strategy many gastroenterologists have used for years: prescribing the right drugs for the right patients to protect them from worsening problems that interfere with their lives.
Plan of attack
Biologics are already used to treat immune-based conditions such as multiple sclerosis, psoriasis, and rheumatoid arthritis. Because the GI tract breaks down proteins, pills won’t work for this type of medication, so they’re given by injection or infusion.
But while the route of administration may not be as convenient as taking a pill, biologics target Crohn’s better than the two medications that used to be the standard first-line treatment. Corticosteroids and aminosalicylates were part of a “step-up” approach to tamp down intestinal inflammation and prevent Crohn’s complications. But those drugs work like a leaky bandage that does nothing to fix the underlying problem, and steroids, in particular, come with a host of harmful side effects, including bone thinning, serious infections, cataracts, and elevated blood sugar levels.
Biologics, however, are antibodies that stop specific proteins in the body from causing inflammation. Biologics work best when they’re given earlier, not after other drugs fail. Prescribing them sooner for patients considered at high risk of worsening Crohn’s will help stop the disease in its tracks, before bowel damage progresses. It aims a fire hose on the blazing forest.
There are many biologic drugs available. The AGA recommends starting with a type of biologic called an anti-tumor necrosis factor agent, such as infliximab (Remicade), adalimumab (Humira), or certolizumab pegol (Cimzia), or either ustekinumab (Stelara), or vedolizumab (Entyvio).
Your physician will work with you to choose the medication that best suits your individual needs.