In 1932, Dr. Burrill Crohn and two colleagues presented a paper to the American Medical Association describing the details of what we now call Crohn’s disease. Since then, treatment options have evolved to include biologics, drugs made from living cells that are designed to target inflammation. Inflammation is the core cause of Crohn’s symptoms and complications. When you’re in remission, your inflammation fades. When you are experiencing a Crohn’s flare, your inflammation returns. While there is no cure for Crohn’s, the goal of treatment is to reduce inflammation to put the disease into remission, and to keep it there. How biologics target inflammation Tumor necrosis factor, or TNF, is a protein that induces inflammation as part of an immune system response. Anti-TNF biologics work by targeting this protein to reduce its inflammatory properties. If you take Remicade (infliximab), Humira (adalimumab) or Simponi (golimumab) you are taking an anti-TNF biologic. Another way that biologics target inflammation is by addressing the problem of too many white cells. Entyvio (vedolizumab) is an integrin blocker that works this way. Integrin blockers and selective adhesion molecule inhibitors (SAM) stop white blood cells from entering the stomach. This blocking action keeps the white cells away from areas of inflammation and allows them to recover. What is remission? It’s normal to have good days and bad days when you have Crohn’s, so how do you know if you’re in remission and not just having several good days? You are in remission if you have no noticeable symptoms (clinical remission), and tests indicate your lesions are healing (tissue remission) and your blood has normal inflammation levels. The Crohn’s disease activity index (CDAI) is a tool you can use to measure the degree to which your Crohn’s is active. A score of 150 or less is considered remission. Even while you’re in remission, it’s common for a biopsy to show microscopic changes to your tissue that indicate previous inflammation. Sometimes, in the case of prolonged and deep remission, biopsy results are normal, but this is not usually the case. How biologics keep you in remission Biologics keep you in remission by blocking your immune system’s over active inflammation response. If you go off your medication while in remission, you’re more at risk for reacting with a flare to a trigger. Sometimes triggers can be hard to predict. Others are easier to identify: Dietary changes Cigarette smoking Medication changes Stress Air pollution If you are on medication while exposed to triggers, your Crohn’s disease is less likely to be activated. What are biosimilars? Biosimilars, also known as subsequent entry biologics (SEBs), are later versions of biologics with very similar structure, safety and effectiveness. They are not generic versions of the original biologics. Instead they are copies of original biologics whose patent has expired. They generally cost less, and are also effective for maintaining remission. Why you should stick to your treatment even while in remission Once you’re in remission, you may be tempted to stop treatment. If you do, you risk experiencing a new flare. If you stop taking your medication, there is the possibility that it may not work as well the next time you have a flare. This is because when you stop taking a biologic, your body can grow antibodies against the drug which makes it less effective in future, and may even cause adverse reactions. Biologics suppress your immune system, which puts you at rick for infection. Because of this, there are certain situations where your doctor may advise you to take a medication break. These include: Surgery Vaccinations Pregnancy Otherwise, the recommended practice is to stay on the medication even when you are in remission. Studies have shown that only about half of people who stop using their anti-TNF biologic while in remission actually stay in remission for longer than two years, and that number decreases with time. The Takeaway Your goal for your Crohn’s treatment is to obtain and sustain remission. Missed medication can lead to flares. It’s important to work with your doctor to establish the best strategy for staying in remission. This includes regular checkups and maintaining your medication regimen.