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The CD Treatment Puzzle: Where Do Biologics Fit?  Written by Nancy Lovering   Crohn’s disease is characterized by chronic inflammation of the intestinal tract. It interferes with food digestion, nutrient absorption and waste elimination. Left untreated, Crohn’s disease can progress to cause permanent damage to your bowels. It can even lead to life threatening complications such as a bowel obstruction or colon cancer.  Fortunately, there are treatment options available. There is no cure, but Crohn’s can be put into remission with treatment.

The goal of treatment is to calm inflammation, stop intestinal damage and to produce and maintain remission.   Medicinal treatment for Crohn’s consists of conventional medications as well as biologics, which are made from living cells. They are effective at putting Crohn’s into remission and keeping it there, but they put you at a higher risk for infection and certain cancers.   Your doctor will discuss treatment options to help you decide the most beneficial approach in your case.   Antibiotics  Antibiotics are used to treat infections that occur as a result of Crohn’s. They can also help your Crohn’s by reducing the number of bacteria in the intestines which your immune system may mistakenly be attacking, resulting in your symptoms.   Aminosalicylates (5-ASAs)  These drugs help to treat mild to moderate Crohn’s by reducing inflammation in the intestinal lining.

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They don’t have a risk of infection or cancer the way that some medications do, but they are more effective for colitis and don’t work as well as a stand-alone treatment for Crohn’s. They are generally safe although you shouldn’t use them if you have kidney problems.  Corticosteroids (steroids)  Moderate to severe Crohn’s can be treated with steroids to suppress the immune system. They work by mimicking cortisol, a substance naturally produced by your body that fights inflammation.  Steroids shouldn’t be used for a long period of time or you can become dependent or resistant to them. If you become dependent on steroids, you may not be able to stop using them without experiencing a flare.

If this is the case, your doctor will help transition you to another type of medication so you can stop using the steroids.  Immunomodulators  These immune modifiers suppress your body’s immune system so that it’s less responsive and less likely to cause chronic inflammation. This is the same medication given to organ transplant recipients so that their bodies won’t reject new organs. It’s also useful for Crohn’s treatment, and works to enable you to transition off steroid medication.  Immunomodulators put you at increased risk for infection, as well as sometimes have adverse effects on blood pressure and kidney functions.

Certain immunomodulators are not recommended during pregnancy.  Biologics  Treatments for Crohn’s have evolved to include medication called biologics. Made from living cells, biologics target the inflammation process. Designed to treat moderate to severe Crohn’s, biologics are often the next step after conventional therapies have not worked.

   Biologics promote bowel healing as well as bring about and maintain remission. Because they target specific mechanisms of the inflammation process, they don’t suppress the overall immune system the way that some drugs do. However, they do create problems such as reduced infection resistance and increased cancer risk.  Biologics work in one of two ways. Anti-TNF biologics target inflammation-causing tumor necrosis factor (TNF).  Integrin blocker biologics and selective adhesion molecule inhibitors (SAM) block inflammation causing cells from finding vulnerable areas in the gut so it has time to heal.

   Traditionally biologics have been used as part of a “step-up” approach when other treatments fail to produce desired results. More doctors are seeing the benefits of starting earlier as part of a “top down” strategy: when biologics are given sooner they may prevent some damage before it starts.   Biosimilars  Biosimilars are copies of biologics which have expired licenses.

They are similar enough to be safe and effective but are more cost-effective.    The Takeaway  Crohn’s is not curable but there are several treatment options available. The goal of treatment is to reduce inflammation and to put the disease into remission. Biologics are very effective for achieving remission but also have side effects.

Your doctor will help you decide if and how soon you should try biologics.