Disease “flares” are primarily treated with either corticosteroid or biological anti-inflammatory agents. Other agents may be used as maintenance therapy between flares.
Treatment is limited to off-label use of steroids (e.g. prednisone), local steroids targeting the distal GI tract only, and other anti-inflammatory treatments and second-line use of biologics.
Prednisone (steroid) Treatment
When changes in nutrition and lifestyle are inadequate to control Crohn’s disease flares, immediate treatment is often initiated with high doses of prednisone.
Prednisone is a steroid that helps to control the inflammation. However, steroids have a number of associated side effects, including causing high blood pressure, glucose intolerance, reduced bone mass, cataracts, decreased growth and increased risk of infections. Some of these side effects further exacerbate complications from the disease itself such as lack of growth. Because the prednisone can reach all areas of the body (systemically), all these side effects occur. Due to the severity of side effects, treatment is kept as minimal as possible.
Unfortunately, steroid use can also lead to steroid dependence, such that stopping treatment with the steroids results in immediate disease flare ups.
There are two FDA approved treatments for severe disease that have failed conventional (e.g., steroid) therapy. These treatments suppress specific inflammatory signaling in the body.
Both products are associated with BLACK BOX warnings for causing cancer (e.g., lymphoma) and increasing risk of life-threatening infection.