Kimberly Weaver, MD, tells Stephanie Watson
I am fortunate to serve as a gastroenterologist at a time when we have many excellent options for treating Crohn’s disease, including new biologic and small molecule drugs. The number of new treatments researchers are studying in clinical trials makes me more hopeful about the outlook for people with this chronic inflammation.
choose the right treatment
Treatment for Crohn’s disease is very individualized. I always try to involve my patients in the decision-making process. When choosing a drug, I consider its effectiveness and safety. I also consider something like this:
- person’s age
- their overall health
- whether they also have skin and joint problems
- where and how severe is their intestinal inflammation
- whether they have stenosis or any other complication of Crohn’s disease
We also discussed their values, including whether they would rather have an injection at home or an infusion in the hospital.
The goals of treatment for Crohn’s disease are to improve symptoms and quality of life while preventing complications. We usually use the “treatment target” strategy. This means we try to clear the symptoms and inflammation so that the disease goes into remission.
Biological product
Biologics are drugs we prescribe for moderate to severe Crohn’s disease. These are large proteins made by living organisms. They target specific processes in the body that trigger inflammation.
Several classes of biologics are approved to treat Crohn’s disease. Each targets a different protein that causes inflammation.
We have medicines that inhibit a protein called tumor necrosis factor (TNF), including:
- Adalimumab (Humira)
- Pegylated certolizumab (Cimzia)
- Infliximab (Remicade)
Recently approved biologics include:
- Ustekinumab (Stelara), which works by blocking the proteins interleukin 12 and 23 (IL-12 and IL-23)
- Vedolizumab (Entyvio), which prevents white blood cells from entering the gut
Biosimilars are nearly identical copies of already approved biologic drugs. They have the same efficacy and safety profile as biological therapies originally approved for patients with Crohn’s disease. They include:
- Infliximab (Renflexis)
- Infliximab-axxq (Avsola)
- Infliximab (Inflectra)
Surgery has always played an important role in managing Crohn’s disease, and it can save lives. But thanks to these newer drugs, surgery rates appear to be declining. Our medicines can better control inflammation, so they can help people avoid surgeries they may have needed in the past.
look for better results
We are working to better understand which patients respond best to specific drugs, especially as our pool of therapeutics has expanded. We’re trying to identify biomarkers — substances in a person’s blood — that help us find the right treatment for them.
We know that some people with Crohn’s disease carry a genetic marker called the human leukocyte antigen (HLA) DQA1*05 allele. This may put them at high risk of developing antibodies against TNF biologics. This can make these drugs less effective.
If we know someone has this marker, we usually use a combination of anti-TNF biologics and immunomodulatory drugs. Or we use a non-anti-TNF biologic as the first treatment.
Checking this mark is not part of our standard practice as insurance may not cover the cost. But in the future, having blood tests to check for this or other markers could help us choose the best treatment for a particular patient.
why i’m optimistic
These are exciting times for treating Crohn’s disease. We have come a long way in diagnosing and managing this disease. And we’re getting better at preventing complications.
Many drugs are being developed for Crohn’s disease, some with new therapeutic targets. Some of these are pills, including:
- Sphingosine-1-phosphate (S1P) receptor modulator ozanimod (Zeposia)
- Selective Janus kinase (JAK) 1 inhibitor upadacitinib (Rinvoq)
This is exciting because people can take them orally rather than having to go to a doctor’s office for an infusion or give themselves shots.
I’m also excited that a drug that blocks IL-23 has been approved for the treatment of moderate to severe Crohn’s disease in adults. Risankizumab-rzaa (Skyrizi) is approved in 2022 as the first IL-23 blocker. For another inflammatory disease – psoriasis – a head-to-head study found that an IL-23 inhibitor was more effective than ustekinumab (Stelara) and adalimumab (Humira).
remaining challenges
Like most other long-term diseases, including high blood pressure and diabetes, we still have no cure for Crohn’s disease. It’s hard to say how far we are from one. Crohn’s disease is complex. A combination of genetics, immune system, environment and lifestyle factors play a role in causing it.
In addition, there are many different types of Crohn’s disease. A person with inflammation of only the small intestine may be different from a person with inflammation of the colon. Some patients have a very mild course. Others are so severely ill that complications such as strictures or fistulas develop. Unfortunately, there is no panacea for all forms of the disease.
Another challenge is the high cost of treatment. Biologic drugs can be very expensive. Depending on insurance coverage, a single treatment can cost thousands of dollars.
We need to make these medicines more affordable so everyone can get them. Despite my efforts to provide the best care for my patients, insurance companies often deny coverage for biologic drugs. This includes treatments that my patients have been receiving for many years.
Learn more about Crohn’s disease
Our goal is to develop more effective treatments for Crohn’s disease. We continue to work hard to find a cure and, ultimately, a way to prevent this condition.
Clinical trials offer new and emerging treatments for people with Crohn’s disease. If you want to learn more about clinical trials, talk to the gastroenterologist who treats your Crohn’s disease, or visit the Crohn’s and Colitis Foundation website.
