Therapy

Long-term therapy for Crohn’s disease always begins in remission, i.e. when the patient is not in a relapse. Long-term therapy with mesalazine (5-ASA) is desirable because it is effective and has few side effects. In some patients this one drug is already sufficient to control the disease.

If this is not the case, additional cortisone, in the lowest possible dosage, is used locally (as enema or klysma) or systemically (as tablets). Alternatively, immunomodulators such as methotrexate (MTX) or azathioprine can be used. Unfortunately, the latter can be associated with severe side effects, which is why patients often need to be re-examined.

Good experience has also been made with the relatively new TNF blockers (e.g. Humira®) in long-term therapy. In case of severe complications such as constrictions, fistulas or abscesses, surgical removal of the affected intestinal sections may be necessary. Humira® belongs to the relatively new group of TNF blockers.

The active ingredient of the drug is called adalimumab. Remicade® (Infliximab) is another well-known representative of this group of active ingredients. As an antibody, it “intercepts” TNF circulating in the body.

TNF in turn is a molecule that is released by inflamed cells to attract inflammatory cells of the immune system and stimulate them to multiply. If it is eliminated by Humira®, the inflammation is thus attenuated. It is used in Crohn’s disease when other drugs do not bring the desired success.

It must be regularly injected directly into the bloodstream.Side effects include non-specific reactions such as muscle pain, skin rashes, loss of appetite and increased risk of infection. A dormant tuberculosis can be reactivated by Humira®, which is why it should be ruled out before starting therapy. The type of treatment always depends on the severity of the relapse.

In general, dietary measures are taken first to relieve the intestine and to remove any allergens present in the food from the body. In some cases, special liquid food or nutrition “through the vein” (parenteral nutrition) is used for the duration of the relapse. In terms of medication, mesalazine (5-ASA) and cortisone in local form, i.e. as enemas or klysma (suppositories), are used first. If the inflammation cannot be contained in this way, cortisone administered systemically, i.e. as tablets or intravenously, must be used. In case of further therapy failure, immunomodulators such as azathioprine or methotrexate are used.