The most common treatments for inducing remission in Crohn's
disease continue to be oral or intravenous corticosteroid
medications such as prednisone. They also have a role in managing
less severe disease and in treating small bowel involvement.
Steroids are used for short-term therapy and other medications are
used to maintain remission following steroids. Steroids work by
reducing inflammation throughout the body and thus long-term use is
associated with many side effects like osteoporosis, diabetes, and
hypertension. Promising results have been obtained with the use of
budesonide (Entocort), a corticosteroid with high topical
anti-inflammatory activity and low systemic activity. This
medication, though costly, can reduce the intestinal inflammation
while minimizing the side effects that would be commonly
experienced with prednisone.
Another category of drugs often used in Crohn's disease are the
5-aminosalicylates such as mesalamine (Asacol, Pentasa),
sulfasalazine (Azulfidine), and balsalazide (Colazal). These
medicines are quite safe, but may require large doses.
Immunomodulatory drugs such as azathioprine (Imuran, Azasan),
6-mercaptopurine (Purinethol), or methotrexate are often effective
in maintaining remission of Crohn's disease. These medications are
used long-term and require monitoring to prevent adverse effects.
They work by changing the way certain inflammatory cells in the
intestinal lining respond to inflammatory triggers.
Infliximab (Remicade) is another powerful anti-inflammatory drug
that blocks the action of a specific molecule called tumour
necrosis factor (TNF), this is a key mediator of the inflammatory
process in Crohn's disease. It is indicated for perianal Crohn's
disease or intestinal disease not responding to the usual
first-line medications. This drug is actually a synthetic antibody
and is given as an intravenous infusion for both induction and
maintenance of remission. Important side effects of this medication
are infusion reactions (rash, fever) and, rarely, serious
infections. Other medications known as biologicals, of which
infliximab is one, are being studied and may emerge as viable
therapies for Crohn's disease in the future.
