Editing Crohn's disease (section)

=== Medication ===
Acute treatment uses medications to treat any infection (normally [[antibiotic]]s) and to reduce inflammation (normally [[corticosteroid]]s). When symptoms are in remission, treatment enters maintenance, intending to avoid the recurrence of symptoms. Prolonged use of corticosteroids has significant [[Adverse effect (medicine)|side-effects]]; as a result, they are, in general, not used for long-term treatment. Alternatives include aminosalicylates alone, though only a minority can maintain the treatment, and many require immunosuppressive drugs.<ref name="HanauerCrohns" /> It has also been suggested that antibiotics change the enteric flora, and their continuous use may pose the risk of overgrowth with pathogens such as ''[[Clostridioides difficile (bacteria)|Clostridioides difficile]]''.<ref name="Shanahan">{{cite journal | vauthors = Shanahan F | title = Crohn's disease | journal = Lancet | volume = 359 | issue = 9300 | pages = 62–69 | date = January 2002 | pmid = 11809204 | doi = 10.1016/S0140-6736(02)07284-7 | s2cid = 743620 }}</ref>

Medications used to treat the symptoms of Crohn's disease include [[mesalazine|5-aminosalicylic acid]] (5-ASA) formulations, [[prednisone]], immunomodulators such as [[azathioprine]] (given as the prodrug for [[6-mercaptopurine]]), [[methotrexate]],<ref name="pmid29338679">{{cite journal | vauthors = Djurić Z, Šaranac L, Budić I, Pavlović V, Djordjević J | title = Therapeutic role of methotrexate in pediatric Crohn's disease | journal = Bosnian Journal of Basic Medical Sciences | volume = 18 | issue = 3 | pages = 211–216 | date = August 2018 | pmid = 29338679 | pmc = 6087553 | doi = 10.17305/bjbms.2018.2792 }}</ref> and [[anti-TNF]] therapies and [[monoclonal antibodies]], such as [[infliximab]], [[adalimumab]],<ref name="Podolsky">{{cite journal | vauthors = Podolsky DK | title = Inflammatory bowel disease | journal = The New England Journal of Medicine | volume = 347 | issue = 6 | pages = 417–429 | date = August 2002 | pmid = 12167685 | doi = 10.1056/NEJMra020831 | url = http://gut.bmj.com/cgi/content/short/39/Suppl_1/A15 | access-date = September 4, 2018 | url-status = live | type = Submitted manuscript | archive-url = https://web.archive.org/web/20210428151606/https://gut.bmj.com/cgi/content/short/39/Suppl_1/A15 | archive-date = April 28, 2021 }}</ref> [[certolizumab]],<ref>{{cite press release |url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2008/ucm116882.htm |title=FDA Approves Cimzia to Treat Crohn's Disease |publisher=[[Food and Drug Administration]] (FDA) |date=April 22, 2008 |access-date=November 5, 2009 |url-status=live |archive-url=https://web.archive.org/web/20091020111256/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2008/ucm116882.htm |archive-date=October 20, 2009}}</ref> [[vedolizumab]], [[ustekinumab]],<ref>{{cite web |title=Prescribing information ustekinumab |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/125261s147lbl.pdf |website=FDA |access-date=May 23, 2019 |archive-date=October 18, 2020 |archive-url=https://web.archive.org/web/20201018151109/https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/125261s147lbl.pdf |url-status=live}}</ref> [[natalizumab]],<ref>{{cite journal | vauthors = Sandborn WJ, Colombel JF, Enns R, Feagan BG, Hanauer SB, Lawrance IC, Panaccione R, Sanders M, Schreiber S, Targan S, van Deventer S, Goldblum R, Despain D, Hogge GS, Rutgeerts P | title = Natalizumab induction and maintenance therapy for Crohn's disease | journal = The New England Journal of Medicine | volume = 353 | issue = 18 | pages = 1912–1925 | date = November 2005 | pmid = 16267322 | doi = 10.1056/NEJMoa043335 | collaboration = International Efficacy of Natalizumab as Active Crohn's Therapy (ENACT-1) Trial Group; Evaluation of Natalizumab as Continuous Therapy (ENACT-2) Trial Group | doi-access = free | title-link = doi }}</ref><ref>{{cite journal | vauthors = Nelson SM, Nguyen TM, McDonald JW, MacDonald JK | title = Natalizumab for induction of remission in Crohn's disease | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 8 | pages = CD006097 | date = August 2018 | pmid = 30068022 | pmc = 6513248 | doi = 10.1002/14651858.CD006097.pub3 }}</ref>[[Risankizumab|risankizumab-rzaa]], and [[upadacitinib]]<ref>{{Cite web |title=Discover RINVOQ® (upadacitinib) |url=https://www.rinvoq.com/ |access-date=May 29, 2023 |website=RINVOQ |archive-date=May 18, 2023 |archive-url=https://web.archive.org/web/20230518231109/https://www.rinvoq.com/ |url-status=live}}</ref> [[Hydrocortisone]] should be used in severe attacks of Crohn's disease.<ref name="OHCM">{{cite book |vauthors=Longmore M, Wilkinson I, Turmezei T, Cheung CK |title=Oxford Handbook of Clinical Medicine |edition=7th |publisher=[[Oxford University Press]] |year=2007 |pages=266–7 |isbn=978-0-19-856837-7}}</ref> [[Biological therapy for inflammatory bowel disease|Biological therapies]] are medications used to avoid long-term steroid use, decrease inflammation, and treat people who have fistulas with abscesses.<ref name="ustekinumab" /> The monoclonal antibody ustekinumab appears to be a safe treatment option, and may help people with moderate to severe active Crohn's disease.<ref name="MacD2016">{{cite journal | vauthors = MacDonald JK, Nguyen TM, Khanna R, Timmer A | title = Anti-IL-12/23p40 antibodies for induction of remission in Crohn's disease | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 11 | pages = CD007572 | date = November 2016 | pmid = 27885650 | pmc = 6464484 | doi = 10.1002/14651858.CD007572.pub3 }}</ref> The long term safety and effectiveness of monoclonal antibody treatment is not known.<ref name="MacD2016" /> The monoclonal antibody [[briakinumab]] is not effective for people with active Crohn's disease and it is no longer being manufactured.<ref name="MacD2016" />

The gradual loss of blood from the gastrointestinal tract, as well as chronic inflammation, often leads to anemia, and professional guidelines suggest routine monitoring for this.<ref name="Mowat2011">{{cite journal | vauthors = Mowat C, Cole A, Windsor A, Ahmad T, Arnott I, Driscoll R, Mitton S, Orchard T, Rutter M, Younge L, Lees C, Ho GT, Satsangi J, Bloom S | title = Guidelines for the management of inflammatory bowel disease in adults | journal = Gut | volume = 60 | issue = 5 | pages = 571–607 | date = May 2011 | pmid = 21464096 | doi = 10.1136/gut.2010.224154 | s2cid = 8269837 | collaboration = IBD Section of the British Society of Gastroenterology }}</ref><ref name="ReferenceA">{{cite journal | vauthors = Goddard AF, James MW, McIntyre AS, Scott BB | title = Guidelines for the management of iron deficiency anaemia | journal = Gut | volume = 60 | issue = 10 | pages = 1309–1316 | date = October 2011 | pmid = 21561874 | doi = 10.1136/gut.2010.228874 | doi-access = free | title-link = doi }}</ref><ref name="ReferenceB">{{cite journal | vauthors = Gasche C, Berstad A, Befrits R, Beglinger C, Dignass A, Erichsen K, Gomollon F, Hjortswang H, Koutroubakis I, Kulnigg S, Oldenburg B, Rampton D, Schroeder O, Stein J, Travis S, Van Assche G | title = Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases | journal = Inflammatory Bowel Diseases | volume = 13 | issue = 12 | pages = 1545–1553 | date = December 2007 | pmid = 17985376 | doi = 10.1002/ibd.20285 | doi-access = free | title-link = doi }}</ref>