Treatment Rx Drugs

(Under Construction) Drugs Commonly Prescribed for Treatment and Side Effects, Symptoms and Warnings

Immune system suppressors
These drugs also reduce inflammation, but they target your immune system rather than directly treating inflammation. By suppressing the immune response, inflammation is also reduced. Sometimes, these drugs are used in combination. For example, a combination of azathioprine and infliximab has been shown to work better than either drug alone in some people. Immunosuppressant drugs include:

·                                 Azathioprine (Imuran) and mercaptopurine (Purinethol). These are the most widely used immunosuppressants for treatment of inflammatory bowel disease. If you're taking either of these medications, you'll need to follow up closely with your doctor and have your blood checked regularly to look for side effects, such as a lowered resistance to infection. These drugs may also cause nausea and vomiting.

·                                 Infliximab (Remicade). This drug is for adults and children with moderate to severe Crohn's disease. It may be used soon after diagnosis, particularly if your doctor suspects that you're likely to have more severe Crohn's disease or if you have a fistula. It's also used after other drugs have failed. It may be combined with an immunosuppressant in some people, but this practice is somewhat controversial. Infliximab works by neutralizing a protein produced by your immune system known as tumor necrosis factor (TNF). Infliximab finds TNF in your bloodstream and removes it before it causes inflammation in your intestinal tract.

Some people with heart failure, people with multiple sclerosis, and those with cancer or a history of cancer can't take infliximab or the other members of this class (adalimumab and certolizumab pegol). Talk to your doctor about the potential risks of taking infliximab. Tuberculosis and other serious infections have been associated with the use of immune-suppressing drugs. If you have an active infection, don't take these medications. You should have a skin test for tuberculosis, a chest X-ray and a test for hepatitis B before taking infliximab.

·                                 Adalimumab (Humira). Adalimumab works similarly to infliximab by blocking TNF for people with moderate to severe Crohn's disease. It can be used soon after you're diagnosed if you have a fistula, or if you have more severe Crohn's disease. It also may be used after other medications have failed to improve your symptoms. Adalimumab may be used instead of infliximab or certoluzimab pegol, or it can be used if infliximab or certoluzimab pegol stop working. Adalimumab may reduce the signs and symptoms of Crohn's disease and may cause remission.

However, adalimumab, like infliximab, carries a small risk of infections, including tuberculosis and serious fungal infections. You should have a skin test for tuberculosis, a chest X-ray and a test for hepatitis B before taking infliximab. The most common side effects of adalimumab are skin irritation and pain at the injection site, nausea, runny nose, and upper respiratory infection.

·                                 Certolizumab pegol (Cimzia). Approved by the Food and Drug Administration (FDA) for the treatment of Crohn's disease, certolizumab pegol works by inhibiting TNF. Certolizumab pegol is prescribed for people with moderate to severe Crohn's disease. Certolizumab pegol may be used instead of infliximab or adalimumab, or it can be used if infliximab or adalimumab stop working. Common side effects include headache, upper respiratory infections, abdominal pain, nausea and reactions at the injection site. Like other medications that inhibit TNF, because this drug affects your immune system, you're also at risk of becoming seriously ill with certain infections, such as tuberculosis. You should have a skin test for tuberculosis, a chest X-ray and a test for hepatitis B before starting certolizumab pegol.

·                                 Methotrexate (Rheumatrex). This drug, which is used to treat cancer, psoriasis and rheumatoid arthritis, is sometimes used for people with Crohn's disease who don't respond well to other medications. Short-term side effects include nausea, fatigue and diarrhea, and rarely, it can cause potentially life-threatening pneumonia. Long-term use can lead to scarring of the liver and sometimes to cancer. Avoid becoming pregnant while taking methotrexate. If you're taking this medication, follow up closely with your doctor and have your blood checked regularly to look for side effects.

·                                 Cyclosporine (Gengraf, Neoral, Sandimmune). This potent drug, often used to help heal Crohn's-related fistulas, is normally reserved for people who haven't responded well to other medications. Cyclosporine has the potential for serious side effects, such as kidney and liver damage, seizures, and fatal infections. This medication isn't for long-term use.

·                                 Natalizumab (Tysabri). This drug works by inhibiting certain immune cell molecules — integrins — from binding to other cells in your intestinal lining. Blocking these molecules is thought to reduce chronic inflammation that occurs when they bind to your intestinal cells. Natalizumab is approved for people with moderate to severe Crohn's disease with evidence of inflammation and who aren't responding well to other conventional Crohn's disease therapies including TNF blockers and immunomodulators. Because the drug is associated with a rare, but serious, risk of multifocal leukoencephalopathy — a brain infection that usually leads to death or severe disability — you must be enrolled in a special restricted distribution program to use it.

Medications and cancer risk
Immune system suppressors also are associated with a small risk of developing cancer such as lymphoma. These include azathioprine, mercaptopurine, methotrexate, infliximab, adalimumab, certolizumab pegol and others. The risk may be due to the immune system suppression that these medications cause. While these medications do increase risk, they may be necessary for people with Crohn's disease to improve quality of life and avoid surgery or hospitalization. Work with your doctor to determine which medications are right for you.