Drugs

Different groups of drugs are used in Crohn’s therapy and prophylaxis (). An important group are glucocorticoids, also known as cortisone preparations. A distinction is made between systemic and topical, i.e. only locally effective cortisone preparations.

Therapy with cortisone is an integral part of Crohn’s disease treatment. In addition to cortisone, the term steroids or glucocorticoids/corticoids is often used in medicine. All these terms refer to the active ingredient cortisone.

Cortisone is not only a drug, but also a messenger substance (hormone) that the body produces itself, namely in the adrenal gland. Cortisone can be produced artificially and used as a drug. Cortisone is therefore both a hormone and a drug produced by the body.

When used as a drug, a much higher dosage is used than is normally found in the body. Cortisone has many effects. The main effect is the suppression of the immune system.

This is useful in an acute flare of Crohn’s disease, as the drug reduces inflammation by inhibiting the immune system. In addition, cortisone acts on the metabolism, bones and muscles. Cortisone is also known as a stress hormone because in stress situations it activates energy reserves and increases blood sugar levels.

Examples of cortisone preparations are the active ingredients prednisolone (Prednisone®, Decortin® H) and budesonide (Budenofalk®, Entocort®). It is important to know that cortisone must always be expelled. This means that cortisone must not be discontinued abruptly, but that smaller and smaller amounts of cortisone must be taken every day.

Only in this way does the body have time to increase its own cortisone production. Humira® is the trade name of the drug with the active ingredient adalimumab and belongs to the so-called biologicals. Adalimumab is an artificially produced antibody that intervenes very specifically in the immune system.

Antibodies are also found in the healthy immune system. They are small Y-shaped corpuscles that are produced by immune cells and serve to mark pathogens. The antibody inhibits the inflammatory messenger TNF-alpha (tumor necrosis factor-alpha), which is increasingly produced in the intestinal wall in Crohn’s disease.

The messenger substance is, so to speak, intercepted by Humira® and can no longer heat up the immune system. The inflammatory reaction in Crohn’s disease is attenuated and the intestine can recover. Humira® must be stored in a cool place and injected under the skin, e.g. on the stomach.

At the beginning of the therapy a higher dose is needed for the first 2 weeks, after that it is sufficient to inject every 14 days. Possible side effects include acute allergic reactions, irritation of the injection site, skin changes, nausea, vomiting and headaches. Unfortunately, Humira® does not only intervene in the intestine, where the effect is desired, but in the immune system of the entire body.

Thus Humira® can weaken the immune system’s defense against pathogens, which can lead to an increased susceptibility to colds, for example. The defense against the body’s own cancer cells can also be weakened. An increased risk of cancer from Humira® cannot be ruled out according to current research.