How do Azathioprine or biologics help in Crohn’s?

Question

Hello doctor,

I have Crohn’s disease involving the ileum, which was diagnosed at age 21. I tend to experience flares during periods of stress or dietary changes, and recently I have noticed unintentional weight loss. My most recent CRP is elevated at 18 mg/L.

My gastroenterologist suggested transitioning from steroids to an immunomodulator. I would appreciate it if you could explain how treatments such as Azathioprine or biologic therapy work, and what monitoring would be required with these options.

Thank you very much for your guidance.

Answer 1

Hi,

Welcome to icliniq.com.

Thank you for sending in your question.

You have Crohn's ileitis, which is causing you to lose weight and have a high CRP level of 18 mg/L (attachment removed to protect patient’s identity), which means there is active inflammation.

Steroids can help people go into remission, but they shouldn't be used for a long time because they might cause problems like osteoporosis, diabetes, infections, and adrenal suppression.

Steroid-sparing therapy uses immunomodulators or biologics to keep inflammation under control without the long-term negative effects of steroids.

1. Azathioprine (AZA)

It works by lowering the number of immune cells that are too active, which helps keep remission going and lowers the danger of antibodies developing against biologics.
It usually takes six to 12 weeks for the first signs to show up, but it can take three to four months.
Before starting, you should get a TPMT/NUDT15 test if you can, a CBC, LFTs, screening for hepatitis and TB, and updates on your vaccinations.
Monitoring: CBC and LFTs every one to two weeks at first, then every one to three months.
Keep an eye out for nausea, pancreatitis, low white blood cells, and liver damage. There is a slight chance of getting lymphoma or skin cancer in the long run. It is a good idea to protect your skin from the sun and check it regularly.

2. Biologics (such as Ustekinumab, Vedolizumab, IL-23 inhibitors, and Anti-TNF medicines)

Target particular inflammatory pathways and often operate faster and better for moderate to severe Crohn's disease.
Before starting: tests for TB and hepatitis, and a review of vaccinations.
Monitoring: symptoms, CRP or fecal calprotectin, tests now and again, and possibly drug levels or antibodies if the response gets worse.

The severity of the condition, the presence of strictures or fistulas, and how well previous treatments worked all play a role in choosing a treatment. The main aims are to get into deep remission and get back to a healthy weight and overall health.

I hope this answers your questions.

We appreciate your comments and use them to make patient care better.

Thanks.