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Inflammatory Bowel Disease Health Center

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Crohn's Drugs That Target Your Immune System

After you've already tried other treatments for Crohn's disease, your doctor may suggest drugs that curb your immune system. These medications can play a key role in lessening flare-ups.

How They Work

The goal is to reduce inflammation in your gut, which is a cause of your Crohn's symptoms.

The inflammation results from a complicated set of events in your body. Taking drugs that affect your immune system and adding treatments like steroids and antibiotics can break that process. This will ease your symptoms and help prevent flares.

When Are They Used?

There are several reasons your doctor might try these drugs to treat your Crohn's:

Other drugs aren't working: You may get immune system drugs if steroids aren't helping or are only working a little bit. Or there might be a concern that you're becoming too dependent on steroids to lower inflammation.

Keep flares away: These drugs can help keep your Crohn's symptoms from coming back. It may take up to 3 months before they take effect.

Treat a fistula: This type of sore forms a tunnel that goes from one part of your intestine to another. It can also go from your digestive system to nearby areas like your bladder, vagina, anus, or skin.

If you’re having a flare, the doctor might combine one of these drugs with steroids to speed up treatment and curb side effects.

Which Drugs Are They?

You may hear your doctor refer to one type, an immunomodulator. These affect your entire body, not just your gut.

Some common ones are:

  • Azathioprine
  • Methotrexate
  • Mercaptopurine

Azathioprine and mercaptopurine may be used to keep flare-ups at bay. But they may take months to start working. You might a need a faster-acting drug like a steroid until they do. Their side effects include nausea, vomiting, and less resistance to infection.

Methotrexate can help when steroids or other drugs don’t work anymore. Its side effects include:

  • Nausea and diarrhea
  • Fatigue
  • Scarring of the liver if used long-term

Doctors are looking into "top-down therapy" -- using these drugs aggressively to get rid of symptoms. Once that happens, you’ll switch to other types of drugs for long-term treatment.

You and your doctor can discuss which approach makes sense for you.

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