Introduction
Crohn’s disease is a so-called chronic inflammatory bowel disease, or CED for short. It progresses in relapses and is not curable. For this reason, patients are usually forced to take medication throughout their lives to prevent new relapses (remission maintenance). Whereas a few decades ago cortisone was the only known drug for the treatment of Crohn’s disease, we now have a large number of different groups of active ingredients that are suitable for the treatment of an acute relapse, for maintaining remission, or in some cases for both.
What groups of drugs are there?
As already mentioned, a distinction is made between drugs used to treat an acute episode and drugs used to maintain remission. Cortisone preparations still play a major role in acute treatment today, but their use in long-term therapy is prohibited due to the potentially severe side effects. In contrast to the closely related mesalazine (5-ASA), the active substance sulfasalazine has also become established for the treatment of relapses in Crohn’s disease.
Antibiotics are also successfully used to treat relapses, with metronidazole and ciprofloxacin being the drugs of choice. For very severe relapses or relapses that cannot be controlled in any other way, immunomodulators from the group of TNF blockers are also used (Adalimumab, Infliximab). Ultimately, an acute episode may require surgical intervention.
To maintain remission, i.e. in long-term therapy, the active substance mesalazine (5-ASA) is used, especially in pre-operated patients. However, this drug alone is often not sufficient. In such cases, immunosuppressive drugs are used, but these may be accompanied by severe side effects, which is why regular check-ups are mandatory.
Here, methotrexate, azathioprine and the closely related 6-mercaptopurine have become established. An alternative to these immunosuppressants are the TNF-blockers (Infliximab, Adalimumab), which are also used in acute therapy, but which can also trigger undesirable side effects such as allergic reactions or blood count changes in long-term therapy. Vedolizumab, a so-called integrin antagonist, and ustekinumab, an interleukin antagonist, were recently approved for the maintenance of remission in Crohn’s disease. Due to their topicality, there is still little experience of long-term treatment.
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