Biologics

Biologics (also known as biologicals or biopharmaceuticals) are drugs that are very similar or similar to the body’s own proteins. In the case of Crohn’s disease, for example, antibodies are used that attack very specific cells or even just molecules of the body and thus fight inflammation. Adalimumab and Infliximab, both of which are directed against the inflammation mediator TNF, are used in particular.

Also newly approved are the preparations Vedolizumab, an antibody against a specific protein of some immune cells, and Ustekinumab, which is directed against the inflammation mediators Interleukin-12 and Interleukin-23. Since these two biologics have only recently been on the market, there is little data available on long-term effects or side effects when taken over a longer period of time. The advantage of all the above-mentioned biologics is that they have relatively few side effects, as they only have a very specific target in the body and in the best case do not affect other cells and molecules.

Nevertheless, antibodies can also trigger specific side effects. An important side effect is the possible occurrence of allergic reactions. Biologics are usually produced by other organisms and are of non-human origin. Therefore, immune reactions against the “foreign” structures can occur.

Drugs in remission

To maintain remission, drugs are used that have justifiably low side effects in long-term therapy over years or decades. Nevertheless, regular medical check-ups, often including a blood count check, are always necessary to avoid fluctuations in the level of the active substance in the blood. Immunosuppressive drugs are often used here; the active ingredients methotrexate, azathioprine and 6-mercaptopurine are approved for the treatment of Crohn’s disease.

Blood count monitoring is indispensable, especially in long-term immunosuppressive treatment, as these drugs act on the blood-forming system of the bone marrow. Antibodies can also be used as an alternative. Infliximab and adalimumab from the group of TNF blockers, the integrin antagonist vedolizumab and the interleukin antagonist ustekinumab are approved for this purpose. The drug mesalazine, which is an integral part of almost every long-term therapy for the closely related disease ulcerative colitis, unfortunately appears to be ineffective in the long-term treatment of Crohn’s disease. Only pre-operated patients benefit from it.