Treatment can consist of short-term therapies for use during flares as well as long-term maintenance therapy. Treatment during a flare aims to relieve symptoms and bring about remission, or the end of the flare.
Anti-Inflammatory Drugs for Short-Term Use
During a flare, short-term use of anti-inflammatory drugs, such as steroids, can help improve symptoms by reducing inflammation. Your doctor may prescribe them alongside other drugs.
- Corticosteroids Prednisone (Deltasone) and budesonide (Entocort EC) can relieve symptoms and bring about remission. But long-term steroid use can have severe adverse effects, so doctors generally recommend using them for short periods as a bridge to other therapies.
Pain-Relieving Medication
Pain-relieving medications won’t shorten a Crohn’s flare, but they can decrease discomfort while you wait for other drugs to work. These include:
- Antispasmodics, such as dicyclomine (Bentyl), which reduce cramps
- Acetaminophen, such as Tylenol, which relieves pain
Biologics and Other Long-Term Treatments
- Anti-TNF agents such as infliximab (Remicade) and adalimumab (Humira) can shorten a flare. These biologic drugs dampen the immune response by targeting specific molecules and blocking the action of a protein known as tumor necrosis factor, which causes inflammation.
- IL-12/23 and IL-23 inhibitors such as ustekinumab (Stelara) and risankizumab (Skyrizi), respectively, are also biologic drugs. They reduce inflammation by blocking proteins known as interleukins, which play a role in activating the body’s immune response.
- Integrin blockers reduce Crohn’s-related inflammation by targeting precise molecules linked to the gut. Vedolizumab (Entyvio), a biologic drug, blocks the production of one type of integrin, a protein that enables inflammation-causing cells to move from the blood into tissues. It can also act as a maintenance drug between flares.
- JAK inhibitors, which are nonbiologic synthetic small molecule drugs, may relieve symptoms more quickly than other nonsteroid drugs. They reduce inflammation by blocking substances that lead to a faulty immune response, and they can also prevent recurrent flares. In clinical trials, 58.8 percent felt symptom relief after two weeks. Upadacitinib (Rinvoq) was the first JAK inhibitor to get approval from the U.S. Food and Drug Administration (FDA) for treating Crohn’s.
- Immunomodulators such as methotrexate (Trexall) and azathioprine (Imuran) are nonbiologic drugs that reduce inflammation by changing how the immune system works. But it can take 8 to 12 weeks to see an improvement after you start immunomodulators, so they’re not typically used alone for treating acute flares.
Will My Meds Change During a Flare?
A Crohn’s flare doesn’t necessarily mean your medication regimen has stopped working or that you’ll have to change it, says Sobia Mujtaba, MD, MPH, a gastroenterologist and an assistant professor at the Emory University School of Medicine in Atlanta.
“While that is one reason for a flare, [that] a certain medication has lost efficacy, other reasons include infections, or if a medication needs to be optimized,” she says.
Drugs to Avoid
Speak with your doctor before starting or changing any drug or treatment, including over-the-counter drugs, to make sure they won’t worsen your symptoms or interact with other medications.