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Remicade for Crohn’s Disease

By Dr. Landis

July 2018

Crohn's disease is a type of bowel inflammation that may effect any part of the GI tract from mouth to anus. Many people with Crohn's disease have subtle symptoms for years before the diagnosis. Abdominal pain may be the initial symptom and it is often accompanied by diarrhea, which may or may not be bloody. The nature of the diarrhea in Crohn's disease depends on the part of the intestine involved. Small intestine inflammation typically results in large-volume, watery feces. Large intestine inflammation may result in a smaller volume of feces of higher frequency. Bloody bowel movements typically come and go. Complications of Crohn’s can be bowel obstruction, fistulas, abscesses, and anal fissures. Some of these complications can result in repeat hospitalizations, surgery, and death.

Symptoms of Crohn’s can occur outside the bowel. These include inflammation of the eye that can lead to blindness, arthritis that can lead to permanent disability, and skin lesions which are painful.

Treatments are intended to help with symptoms, maintain remission and prevent relapse. Initial treatment is usually with a steroid for a brief period of time to rapidly improve symptoms, alongside a long term immune suppressor to prevent recurrence. These can include but are not limited to azathioprine, methotrexate, sulfasalazine and mesalamine.

When a patient has an incomplete response to these immune system suppressants, Remicade is started. Remicade is a TNF inhibitor used for the treatment of Crohn's disease since 1998. Remicade is administered by intravenous infusion, typically at six- to eight-week intervals. It cannot be given by mouth because the digestive system would destroy the medication, and it would not be absorbed.

Remicade is extremely effective in the treatment of Crohn’s disease. During the clinical trials, 57% of patients had improvement in symptoms two weeks after starting the Remicade. By the fourth week, 81% had improvement in symptoms and 48% had no symptoms of their Crohn’s disease. After 7 months of use, 39-46% had no symptoms of their Crohn’s disease. Remember, these patients were the ones who did not fully respond to the regular immune system suppressants... meaning they had resistant, difficult-to-treat Crohn’s. If you are considering the use of Remicade for your Crohn’s disease, please know that the chances are good it will put your Crohn’s disease in remission.


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