Crohn's Disease Treatment

Because there is no cure for Crohn's disease, the goal of medical treatment is to suppress the inflammatory response. This step accomplishes two important goals: It allows the intestinal tissue to heal and it also relieves the symptoms of fever, diarrhea, and abdominal pain. Once the symptoms are brought under control (this is known as inducing remission), medical therapy is used to decrease the frequency of disease flares (this is known as maintaining remission, or maintenance).

Several groups of drugs are used to treat Crohn's disease today. They are:

1. Aminosalicylates (5-ASA): This class of anti-inflammatory drugs includes sulfasalazine and oral formulations of mesalamine, such as Asacol,® Colazal,.® Dipentum,® or Pentasa,® and 5-ASA drugs also may be administered rectally (Canasa® or Rowasa® ). These medications typically are used to treat mild to moderate symptoms.

2. Corticosteroids: Prednisone and methylprednisolone are available orally and rectally. Corticosteroids nonspecifically suppress the immune system and are used to treat moderate to severely active Crohn's disease. (By "nonspecifically," we mean that these drugs do not target specific parts of the immune system that play a role in inflammation, but rather, that they suppress the entire immune response.) These drugs have significant short- and long-term side effects and should not be used as a maintenance medication. If you cannot come off steroids without suffering a relapse of your symptoms, your doctor may need to add some other medications to help manage your disease.

3. Immune modifiers: Azathioprine (Imuran®), 6-MP (Purinethol®), and methotrexateImmune modifiers, sometimes called immunomodulators, are used to help decrease corticosteroid dosage and also to help heal fistulas. In addition, immune modifiers can help maintain disease remission.

4. Antibiotics: metronidazole, ampicillin, ciprofloxacin, others.

5. Biologic therapies. In August 1998, the FDA approved the first biologic therapy for Crohn's disease. This was infliximab (Remicade®), which is indicated for moderately to severely active Crohn's in patients who have not responded adequately to conventional therapy. It is also approved for reducing the number of draining enterocutaneous fistulas. In June of 2002, infliximab was approved by the FDA for a new indication - maintaining remission. Infliximab is given by infusion.

Infliximab is a chimeric (a hybrid consisting of 75 percent human, 25 percent mouse protein) monoclonal antibody. The antibody works by blocking the immune system's production of tumor necrosis factor-alpha (TNF-alpha). This is a cytokine (chemical) that intensifies inflammation.

Several other biologic agents for both Crohn's disease and ulcerative colitis are being studied in clinical trials currently, but none are yet commercially available.