2015-07-23 19:23:47 UTC

IBD 111: Drug Therapy Details for Crohn's Disease

Learn more about drug therapies for Crohn's Disease in this patient companion, based on the AGA Clinical Guideline "The use of Thiopurines, Methotrexate, and Anti-TNF-α Biologic Drugs for the Induction and Maintenance of Remission in Inflammatory Crohn’s Disease."

Clinical practice guidelines are developed under the guidance of the AGA Institute Clinical Guideline Committee and provide evidence-based recommendations for clinical practice in the field of gastroenterology. The clinical practice guidelines and related Clinical Decision Support Tools support evidence-based clinical decision-making by gastroenterologists and other health-care professionals at the point of care. The below information presents important content from those guidelines in a way that will help patients better understand AGA’s recommendations for evaluating, diagnosing or managing a condition.

AGA Clinical Guideline: The use of Thiopurines, Methotrexate, and Anti-TNF-α Biologic Drugs for the Induction and Maintenance of Remission in Inflammatory Crohn’s Disease

The information provided by the AGA Institute is not medical advice and should not be considered a replacement for seeing a medical professional.

Contents:

What is Crohn's Disease?

Treatment Options

Drugs to Induce Remission of Moderately Severe Crohn’s Disease

Drugs to Maintain Remission of Moderately Severe Crohn’s Disease

 


What is Crohn’s Disease?

  • Crohn’s disease is a form of inflammatory bowel disease, or IBD.
  • In a person with IBD, the immune system damages the digestive tract, causing pain and digestion issues.
  • Symptoms include: 
    • Abdominal pain.
    • Diarrhea.
    • Rectal bleeding.
    • Loss of appetite.
    • Unintentional weight loss.
    • Skin rash.
    • Arthritis (painful, swollen joints).
    • Red, swollen eyes.
    • Fatigue.
  • Untreated Crohn’s disease can lead to serious problems, including: 
    • Painful ulcers of the mouth, digestive tract, anal and genital area.
    • Leaky holes in the digestive tract leading to serious infections.
    • Low iron or other vitamins.
    • Colorectal cancer.
    • Osteoporosis (weak or brittle bones).
    • Liver or gallbladder disease.
  • Crohn’s disease is a life-long disorder. 
  • Up to half a million Americans have Crohn’s disease.

Treatment Options 

  • Many types of drugs are available that can help relieve symptoms, improve health and prevent serious problems.
  • For mild disease, a doctor will usually prescribe antibiotics, steroids or other anti-inflammatory drugs.
  • If a patient does not respond well to those treatments, or if symptoms are more severe, a doctor should prescribe an immune modulator  or a  biological drug .

Immune modulators

  • Drugs that affect the function of immune cells.
  • They can treat a wide range of diseases, from cancer to allergies.

Biological drugs

  • Drugs made from chemicals that are naturally found in living things, such as genes and immune cells.
  • Other examples of biological drugs include vaccines and allergy shots.

Immune modulators and biological drugs that are currently used to treat Crohn’s disease, include:

  • Anti-TNF-α (anti-TNF-alpha) drugs (biological drug).
  • Thiopurines (THY-oh-PYUR-eens) (immune modulator).
  • Methotrexate (METH-oh-TREX-ate) (immune modulator).

 

  • All of these drugs make the immune system less likely to damage the digestive tract.
  • Some of these drugs work better to induce remission, or lessen the symptoms of a Crohn’s disease flare-up.
  • Others work to maintain remission, or to keep the symptoms away after they have been successfully treated, and some do both.
  • These drugs vary in terms of effectiveness, cost and potential side effects.

Use the below chart to talk with your doctor about which treatment options may be best for you. To find a GI in your area, use the  AGA GI Locator Service .

Key

  Green = Positive effect has been confirmed in literature 
Red = Adverse effect has been confirmed in the literature
Yellow = Effect may exist, but has not been confirmed in the literature
Dash = No effect exists

 

 

Drugs to Induce Remission of Moderately Severe Crohn’s Disease

  Anti-TNF-α Drugs (alone) Anti-TNF-α Drugs & Thiopurines (combination)
Effectively relieves symptoms
Raises risk of serious infections (short-term use)
Cost Higher cost Higher cost
Quality of scientific evidence High High
Notes   Taking an anti-TNF-α drug in combination with a thiopurine may be more effective than taking an anti-TNF-α drug alone. Talk to your doctor about the costs and benefits of combination therapy.

 

 

Drugs to Maintain Remission of Moderately Severe Crohn’s Disease

  Thiopurines Methotrexate Anti-TNF-α Drugs
Effectively prevents symptoms from coming back
Raises risk of serious infection (long-term use)
May cause serious side effects
Cost Lower-cost option Lower-cost option Higher cost
Quality of scientific evidence Moderate Low. More reserach is needed. High
Notes

Long-term use can effectively keep symptoms under control in patients who induced remission with a steroid drug. 

Long-term use may increase the risk of infection or lymphoma. However, the risk of these complications is likely lower than the risk of uncontrolled Crohn’s disease. Discuss the risks and benefits of this drug with your doctor.

It is unsure whether long-term use increases the risk of infection or lymphoma. 

Methotrexate can cause miscarriage or birth defects, so patients cannot have a baby while taking this drug.

Long-term use can effectively keep symptoms under control in patients who induced remission with a steroid drug or anti-TNF-α drug. 

Long-term use may increase the risk of infection or lymphoma. However, the risk of these complications is likely lower than the risks of uncontrolled Crohn’s disease. Discuss the risks and benefits of this drug with your doctor.

 

Updated March 2016

©AGA, July 2016

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