There are several types of medications that are frequently used to treat CD, including Azulfadine (sulfasalazine), Asacol and Pentasa (mesalamine), Imuran (azathioprine), Purinethol (6-MP, mercaptopurine), cyclosporine, methotrexate, Remicade (infliximab), and corticosteroids (prednisone).
Azulfadine (sulfasalazine). Sulfasalazine is known as a 5-ASA compound, and is the combination of two drugs: sulfapyridine and an aspirin-like compound. It works to reduce the inflammation in the colon and then as a maintenance therapy to maintain remission. This drug has an extensive history of use for CD, and is considered safe to take for long periods of time. Common side effects–often caused by sensitivity to the sulfa component–include nausea, headache, diarrhea and abdominal pain.
Asacol, Pentasa (Mesalamine) and Dipentum (Olsalazine). Mesalamine and olsalazineare the next generation of 5-ASA compounds, and do not contain the sulfa component. These newer 5-ASA drugs are as effective as sulfasalazine, but tend to have fewer side effects. Mesalamine is found to be most effective in mild or moderate cases of CD. Additionally, mesalamine has been shown to decrease the chances of a relapse after surgery for CD.
Imuran (Azathioprine), Purinethol (6-mercaptopurine, 6-MP) and Sandimmune, Neoral (cyclosporine A). Azathioprine, 6-MP and cyclosporine are immunosuppressants -— a class of drugs that is used to inhibit the immune system. Because CD is an autoimmune disease, suppressing the immune system may lessen symptoms, but also leaves the body more susceptible to infection. Azathioprine and 6-MP have a long history of use for CD, but they are slow acting, and can take 3 to 6 months to induce remission. Therefore these drugs are often combined with another faster-acting drug, such as a corticosteroid. Cyclosporine is quicker, and high doses may induce remission in 1 to 2 weeks, but serious side effects include, kidney damage, liver inflammation, and serious infections.
Rheumatrex (methotrexate). Methotrexate is given by injection and tends to induce remission in 8 to 10 weeks. Side effects range from mild symptoms of nausea, fatigue and vomiting to more serious conditions in bone marrow and the liver. Methotrexate may also cause congenital abnormalities and even death in fetuses, so pregnancy should be avoided, by both men and women, during therapy.
Corticosteroids (prednisone, methylprednisolone). Corticosteroids are similar to cortisol, a steroid the body produces in the adrenal gland. This fast-acting drug reduces inflammation in the body and is usually prescribed to curb an acute flare-up. Corticosteroids are usually given in the lowest possible dosage for the shortest amount of time to reduce incidence of side effects. Care must be taken when lessening the dosage because the body stops or decreases its own production of cortisol during drug therapy. Slowly tapering the amount of the corticosteroids taken daily allows the body to begin producing it again on its own.
Remicade (Infliximab). Infliximab is a monoclonal antibody that stops tumor necrosis factor alpha (TNF-alpha) from being used by the body. TNF-alpha is found in higher than normal amounts in people with Crohn's disease. Infliximab is given by infusion in a hospital or doctor's office setting. Side effects include abdominal pain, nausea, fatigue, vomiting and rarely, infection..
Entocort EC (Budesonide). is used to treat mild to moderate Crohn's disease involving the ileum and/or the ascending colon. Budesonide is a nonsystemic corticosteroid that is released into the intestine and works to reduce inflammation. Because 90% of the drug is released in the intestine and not into the bloodstream, it causes fewer side effects than other corticosteroids (i.e., prednisone). Budenoside is approved for use for up to 8 weeks and side effects include headache, respiratory infection, and nausea.
