While Crohn’s disease can’t be cured, treatments can control the inflammation in your gastrointestinal (GI) tract that causes symptoms.
Biologic drugs are usually the main medical treatment for moderate to severe Crohn’s disease. They can relieve your symptoms and help heal the damage to the lining of your intestines that inflammation causes over time.
Biologic drugs are lab-made versions of immune system proteins called antibodies. They’re created from living cells that have been engineered to grow specific antibodies to target different sources of inflammation. These 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.
Some biologic drugs used to treat Crohn’s disease come in biosimilar versions. These are:
Experts say it may be best to use biologics right away to treat moderate to severe Crohn’s disease, rather than starting with older treatments, like corticosteroids or immunomodulators. While it hasn’t been proven yet in clinical trials, there’s evidence that starting advanced treatment sooner might keep the damage to your intestines from getting so bad that you need surgery. Biologics are often given along with immunomodulators to help them work better.
Because Crohn’s is a lifelong condition, you may take these drugs for as long as they continue to help you.
What Are Biologic Treatments for Crohn’s Disease?
Several different categories of biologic drugs are used to treat moderate to severe Crohn’s disease. Each works to reduce intestinal inflammation in a different way. They are:
What Are Interleukin (IL) Inhibitors?
Interleukin (IL) inhibitors disrupt the chemical signals that trigger abnormal immune system activity. The medications used in Crohn’s disease specifically block the action of two immune system proteins called IL-12 and IL-23. These help cause inflammation in your GI tract and keep it going.
They can also be a good first choice biologic treatment because of how well they work and how safe they are. They’re also less likely to stop working for you over time than other biologics. One biologic — ustekinumab — is available in both the original and biosimilar versions.
Learn more about IL inhibitors for Crohn’s disease.
What Are Integrin Receptor Antagonists?
Integrin receptor antagonists keep infection-fighting white blood cells from getting through the walls of your intestines and increasing inflammation there.
They’re often used as second-line treatments if you’ve tried other medications, including a TNF inhibitor, and your symptoms didn’t improve, or if you can’t stop taking corticosteroids without having your symptoms flare.
Doctors don’t often prescribe natalizumab because of the risk of a deadly brain infection. Vedolizumab only works in your intestines, so it causes fewer side effects. In certain situations, it can be the first treatment you get.
Learn more about integrin receptor antagonists for Crohn’s disease.
What Are TNF Inhibitors?
TNF inhibitors were the first type of biologic drug to be approved for Crohn’s disease treatment in the United States, and they’re still often the first kind prescribed for moderate to severe Crohn’s. They may be the best choice for people with the most severe symptoms.
TNF inhibitors can act quickly, improving symptoms in as little as two weeks. But in some people they work more slowly or not at all.
Because they lower the activity of your immune system, these drugs can put you at risk for serious infections. Your body may also identify a TNF inhibitor as a dangerous germ and start fighting against it. For many people, this causes the drugs to lose their effectiveness.
Adalimumab and infliximab are both available in biosimilar versions in addition to the original.
Learn more about TNF inhibitors for Crohn’s disease.
Things to Consider When Choosing a Treatment
Here are five things to consider when choosing a treatment for moderate to severe Crohn’s disease.