Medicines for Crohn's disease

In Crohn's disease, medications are used to control the inflammation in your colon and to reduce your body’s immune response. 

Often medications are prescribed in a ‘stepped’ approach, depending on your response — beginning with fairly safe medications with few risks or side effects for moderate symptoms, and progressing to stronger medications with additional risks and side effects, for severe symptoms.

The main groups of medicines to treat inflammation in Crohn’s disease are:

• Aminosalicylates 
• Steroids 
• Immunosuppressants 
• Biologics (TNF inhibitors)

• These are often the first treatment option for mild-to-moderate symptoms.
• Aminosalicylates help to reduce the inflammation in the gut and control diarrhoea.
• They may be given by mouth (as tablets or capsules), or by enema or suppository through the rectum (back passage), for mild flare-ups confined to the lower large intestine.
• Examples include oral mesalazine (Asacol®,  Pentasa® and Asamax 500® and  rectal mesalazine (Asacol®, Pentasa® and Asamax 5

• Steroids are used to treat sudden flare ups (when symptoms suddenly get worse) and is not usually continued once the flare-ups have settled.
• In about 7 in 10 cases, symptoms are much improved within 4 weeks of starting steroids.
• Steroids may be given by mouth (as tablets) or through the rectum (back passage), as  enemas or suppositories.
• Rectal steroids are used for mild flare-ups confined to the lower large intestine.
• Steroid injections directly into a vein may be required for a severe flare-up.

Steroids can be given as oral medicine (by mouth) and examples include budesonide (Entocort®), prednisone and methylprednisolone. They can also be given rectally (into your bottom) and an example is hydrocortisone acetate enema  (Colifoam®).

• Immunosuppressants are usually prescribed when symptoms do not respond to other treatments.
• These medicines suppress the immune system and in this way reduce the inflammation in the gut.
• They usually need to be taken for 2 to 4 months before the full benefits are experienced.
• An example is azathioprine.

• TNF inhibitors are used in severe Crohn's disease, in patients who do not respond to other medications, or in people who have a fistula.
• These medications target a protein made by the immune system and in this way, reduce inflammation in the gut. They work quickly to bring on remission.
• In New Zealand TNF inhibitors are funded subject to restrictions (Pharmac subsidy restrictions). To qualify for subsidy the initial application for treatment must come from a gastroenterologist.
• Examples include infliximab (Remicade) and adalimumab (Humira).

Other medications such as antibiotics and vitamin supplements may be prescribed in some situations:

Antibiotics

If you develop an infection, an abscess,  or an infected fistula as a complication of Crohn's disease, you may be prescribed antibiotics such as metronidazole.

Vitamin supplements

Vitamins, either injected or in tablet form, may be used to correct nutritional imbalances that can occur as a result of poor absorption of food and fluid from your bowel.