7 drug options for Crohn's disease

Recent years have given rise to a treatment revolution for the more than 4 million people in the United States who have been diagnosed with an inflammatory bowel disease (IBD), like ulcerative colitis or Crohn’s disease. "Now, more than ever before, we can control these diseases, and we have options that really work," says David Rubin, MD, chief gastroenterologist at the University of Chicago Medicine and director of its Inflammatory Bowel Disease Center.

The goal of treatment is to cut down on inflammation, control symptoms, prevent flares, and improve quality of life. Your treatment plan is unique to your symptoms and disease, but most people with IBD need some prescription medication to keep the disease in check. These common drugs come in various formulations, including oral, topical, rectal, intravenous (IV), and injection.

To manage your IBD, talk with your doctor about these medications to see which option might be best for you.

Corticosteroids

These fast-acting anti-inflammatory drugs work by suppressing the immune system. Symptoms often improve within a few days of use, but corticosteroids aren't a long-term solution. They can help you through a flare or jumpstart relief while you're waiting for slower-acting therapies to kick in. But they should be used only at the lowest dose for the shortest time, if at all. "Corticosteroids carry serious side effects, including a high risk of infections. The goal of good treatment is to avoid steroid use," says Dr. Rubin.

Antibiotics

Antibiotics are mainly used to treat infections and complications. While you might read that antibiotics can be used as long-term therapy to control your symptoms, Rubin says that's not usually recommended.

Immunomodulators

These drugs reduce inflammation by quieting an overactive immune system. They can be used in combination with corticosteroids or biologics. They can take several weeks or up to six months to work and are intended to control IBD symptoms over the long term.

Biologics

This class of IBD drugs is an option for people with moderate to severe disease. Biologics contain engineered proteins that act on specific parts of the immune system to reduce inflammation. Since they act on the immune system, they do carry a risk of infections and other side effects. The main types of biologic drugs are:

• TNF blockers, which block an inflammatory protein called tumor necrosis factor
• Integrin receptor blockers, which block certain immune cells from entering tissue in the intestines, helping to reduce inflammation
• Interleukin (IL) blockers, such as IL-12 and IL-23 blockers, which also block inflammatory proteins called interleukins

JAK Inhibitors

Another kind of medication is called a Janus kinase (JAK) inhibitor. It works by blocking Janus kinase enzymes (proteins involved in immune signaling) inside cells, which contribute to inflammation. A JAK inhibitor may be prescribed if a person:

• Is not suited for a TNF blocker and has already received one approved systemic (body-wide) therapy
• Has an intolerance to a TNF blocker
• Has tried a TNF blocker, and it was not effective

Aminosalicylates

These anti-inflammatory medications are also called 5-ASA drugs because they contain 5-aminosalicylic acid. They aren't the same thing as ASA, more commonly known as aspirin, which can actually worsen IBD. They are often used to treat mild-to-moderate ulcerative colitis, though their use for Crohn's disease is limited to certain situations.

Drugstore options

Over-the-counter (OTC) medications may be used occasionally for symptom relief. These include pain relievers, antidiarrheal medications, and laxatives.

Acetaminophen may be useful for occasional pain relief. Avoid other pain relievers such as ibuprofen, aspirin, or naproxen, which can damage the bowel wall or hinder its ability to heal.

While it may be helpful to take medicine for diarrhea sometimes, always ask an healthcare provider (HCP) first. Also understand that it's not wise to make it a habit. In fact, try not to make a habit of any OTC meds. "We don't want patients relying on over-the-counter treatments to manage their disease," says Rubin.

These options can ease symptoms but don't treat underlying inflammation or damage from IBD, so make sure to speak with your HCP about other medication options.