Medication

Medication is decided based on the severity or the extent of the illness. The National Health Insurance (Kela) pays lower special reimbursement (65 %) for most IBD medicines. You need a medical certificate to get the marking on your Kela card that gives you the reimbursement.

In self-directed treatment, medication is increased when symptoms appear following instructions that have been discussed with the doctor. The clinic is contacted if necessary.

The active ingredient in SASP or salazosulfapyridine (Salazopyrin ®) is mesalazine, which is transported to the large intestine by sulfapyridine. Sulfa may cause allergic reactions and have harmful effects on male fertility.

When the illness flares up, a treatment with cortisone (Budenofalk®, Colifoam®, Cortiment®, Entocort®, Medrol®, Prednison®, Prednisolon®, Solomet®, Solu-Medrol®) is often started either as tablets, rectal foam or for inpatients as injections or infusions. Cortisone alleviates inflammation and usually eases the symptoms quickly, but it also has an immunosuppressive effect. Long-term use is not recommended due to side effects.

Immunosuppressive medication (Imurel®, Sandimmun®, Trexan®, Metoject®, Mercaptopurin®, Ebetrex®, Methotrexate®, Metoject®PEN) is used if 5-ASA or cortisone medication do not work. The response to immunosuppressive medication develops slowly during 3-6 months, and the treatment is continued at least 3-5 years.

Biologic medications (Amgevita®, Entyvio®, Flixabi®, Hukyndra®, Hulio®, Humira®, Hyrimoz®, Idacio®, Imraldi®, Inflectra®, Remicade®, Remsima®, Skyrizi® (1.10.2023 alkaen), Stelara®, Yuflyma®, Zessly®) can be used to treat severe Crohn’s disease. They affect inflammation transmitters or block the white blood cells that maintain inflammation. Some biologic medications are given as infusions in hospitals, others are injected at home. Biosimilars are precise copies of biologic medicines and have similar safety and efficacy profiles.

JAK inhibitors (Rinvoq®) are often categorized alongside biologic medications, but the correct term is small molecule drugs. A JAK inhibitor is an immunosuppressive medication that inhibits the activity of the Janus kinase (JAK) signaling pathway, which amplifies the body’s inflammatory reactions, thereby reducing inflammation activity. The efficacy of drug therapy usually begins quite rapidly, typically within a couple of weeks after starting treatment.

JAK inhibitors are used in the treatment of moderate to severe active inflammatory bowel disease (IBD) in adults when the response to conventional immunosuppressive therapy or biologic drug therapy has been inadequate, response has been lost, or the treatment has not been tolerated.

Due to their mechanism of action, the use of JAK inhibitors increases the risk of viral or bacterial infections, which may be more severe than usual. Shingles may be activated during treatment. Treatment should be suspended in the event of a febrile infection, and the decision to continue medication should be discussed with the treating physician. During febrile infections, it is advisable to consult a doctor more readily than usual.

Changes in the number of blood cells and cholesterol levels may occur with medication and should be monitored during treatment. Headaches, joint pains, and upper respiratory infections may also occur with drug therapy. Vaccines containing live, attenuated pathogens should not be administered during treatment. JAK inhibitors should not be used during pregnancy or breastfeeding.

Antibiotics are used as primary treatment only for fistulas and abscesses.

Over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen or ketoprofen can aggravate Crohn’s disease and increase bleeding. Paracetamol is a safer option to use for fever and as painkiller.

In pediatric Crohn’s disease, the same medications are used as for grown-ups. However, issues such as the effect on growth need to be taken into account when choosing medication.