Treatment for moderate to severe Crohn’s disease is aimed at controlling the inflammation in your gastrointestinal (GI) tract that causes unpleasant symptoms and dangerous complications. Although there’s no cure, medications can give you long-lasting relief from your symptoms and allow the damage done by inflammation to heal.
Drugs called tumor necrosis factor (TNF) inhibitors are a cornerstone of medical treatment for Crohn’s.
What Are TNF Inhibitors for Crohn’s Disease?
TNF inhibitors were the first type of biologic drug to be approved for Crohn’s disease treatment in the United States.
TNF inhibitors are engineered to block specific immune system activity that causes inflammation in your intestines and other parts of your digestive system.
Some TNF blockers come in versions called biosimilars, which are close copies of the original drug. They’ve been proven to work the same way with the same side effects, and they can cost much less.
How Do TNF Inhibitors Work?
A chemical messenger called tumor necrosis factor alpha (TNF-alpha) helps lead your body’s immune response to germs. When a threat is detected, TNF-alpha relays signals that send immune cells to attack the invaders.
In Crohn’s disease, you have an overactive immune response in your GI tract, causing constant inflammation that damages healthy cells. TNF inhibitors break up the chemical signals that cause this, calming the inflammation.
Which TNF Inhibitors Are Used to Treat Crohn’s?
The TNF inhibitors approved to treat moderate to severe Crohn’s disease are:
When Are TNF Inhibitors Used to Treat Crohn’s?
Doctors can prescribe TNF inhibitors in several situations:
How Do You Take TNF Inhibitors?
TNF inhibitors are liquid medications that you take either as a shot under your skin or as an infusion delivered through a needle placed in a vein in your arm (IV). They can be prescribed in combination with immunomodulators to help them work better.
Adalimumab and certolizumab pegol are shots. You give yourself the first adalimumab dose at your doctor’s office so they can make sure you can do it correctly at home. With certolizumab pegol, you can either get shots at your doctor’s office or give them to yourself at home after your doctor shows you how.
Infliximab is an infusion you get at a medical center or a special clinic. It takes about two hours each time. After at least three infusions, you may be able to switch to a shot you give yourself.
How Effective Are TNF Inhibitors?
TNF inhibitors often work quickly to relieve symptoms. Some people see a benefit within two weeks, and all of the TNF inhibitors approved to treat Crohn’s have been shown to help heal the lining of your GI tract. But some people who try one of these drugs don’t get help from them at all.
Here are some results from clinical trials of TNF inhibitors for moderate to severe Crohn’s disease:
A problem that can happen with biologic drugs is a process called immunogenicity. Because a biologic is made from living cells that don’t come from your own body, your immune system may identify it as a dangerous germ and try to protect you from it. Your immune system can make antibodies that attack the drug and remove it from your body more quickly. That means that even if a biologic helps you at first, it may lose effectiveness over time.
This is an issue with TNF inhibitors, and you will likely be prescribed an immunomodulator along with one of these drugs to help keep this from happening. Your doctor will test your blood every so often to see if you have antibodies against the drug and measure how much of it stays in your body between doses. If you seem to be developing immunogenicity, your doctor may recommend increasing your dose, switching to a different TNF inhibitor, or switching to a different type of medication.
Are TNF Inhibitors Safe?
TNF inhibitors, both the original versions and biosimilars, come with a boxed warning about the possibility of serious infections and cancer.
By lowering some of your body’s immune system activity, TNF inhibitors can make it harder for you to fight off an infection, putting you at risk. You’ll be checked for infections, including tuberculosis, before you start treatment. While you’re taking these drugs, the hepatitis B virus can reactivate if you already have it in your system.
It isn’t common, but people taking TNF inhibitors have had other serious side effects, including allergic reactions, low levels of blood cells, heart and blood vessel problems, liver damage, and problems related to abnormal immune system function.
What Are the Common Side Effects of TNF Inhibitors?
TNF inhibitors can also cause milder side effects. Among the most common:
Who Should Not Take TNF Inhibitors?
Infliximab can make heart failure worse. If you have moderate to severe heart failure, make sure your doctor knows. You shouldn’t take it unless your doctor says it’s safe, and even then you should only have the lowest dose.
How Much Do TNF Inhibitors Cost?
Biologic drugs, including TNF inhibitors, are complicated and expensive to make. The drug companies’ list prices — the cost before any discounts or insurance benefits — range from about $35,000 to about $90,000 for a year of treatment.
Your insurance or Medicare plan will likely cover a TNF inhibitor for moderate to severe Crohn’s disease. However, your doctor may have to get approval before they prescribe a certain medication. You might also need to try a biosimilar or less expensive treatment first.
The amount you pay will depend on your plan. Drug companies often have programs to help you with your out-of-pocket costs. You might be able to get medication free of charge if you qualify. You can get more information by following these links:
Clinical Trials of TNF Inhibitors
Clinical trials are an important part of the process of developing new drugs and improving treatments. Researchers test medications in people to learn how effective they are and to find the best ways to use them.
With Crohn’s disease, studies are comparing different biologics to each other, and testing how well they work in combinations. Doctors are also trying to learn if there’s a way to tell which drug will work best for a particular person.
If you’d like to consider taking part in a clinical trial, your first step is to talk to your doctor. They can tell you whether it would be safe for you to participate, and they may be able to steer you toward a particular study that might be helpful. You can also search for trials in your area at ClinicalTrials.gov, a database managed by the U.S. government.
Are TNF Inhibitors Right for Me?
There are more options than ever before for treating moderate to severe Crohn’s disease. While TNF inhibitors are often the first kind of medication recommended, you and your doctor will work together to decide what’s best for you. Here are four things to discuss.