Stelara for Crohn’s Disease
by Dr. Jeffrey Landis
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 with 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, different biologic medications, which have been developed to keep the Crohn’s in remission, may be prescribed.
Stelara is one of the biologic medications that can be used as treatment for Crohn’s disease. Stelara is an IL-12/23 inhibitor that is particularly effective in treating Crohn’s disease. In clinical trials, 58% of patients had a clinical response by the 8th week, with 40% of those patients able to achieve remission.
Stelara’s treatment course is different from the treatment of psoriatic arthritis, which is an injection every 12 weeks. For Crohn’s, there is an initial infusion of Stelara, based on the patients weight, followed by a Stelara injection every 8 weeks. This method has been found to be effective in the treatment of the Crohn’s disease and its related arthritis.
The most common side effects were infections and injection site reactions. There is an increased risk for malignancies. All patients need to be screened for Tuberculosis prior to treatment.
Overall, Stelara is an easy and effective treatment for Crohn’s disease, with a relative low risk for side effects.