As an alternative to sulfasalazine, oral 5-ASA has been packaged into several different delivery forms, without the need for sulfapyridine. These newer agents avoid the side effects related to sulfapyridine and significantly improve the effectiveness of the medication in patients with Crohn's disease of the small intestine. One drawback to these alternatives has been the increase costs of the medications. Enema and rectal suppository forms of mesalamine are available as well. Such preparations appear to be as effective as oral medications in active disease of the distal colon and rectum.
Further trials are ongoing.
Their use in more proximal disease is obviously limited. Corticosteroids are very effective in active Crohn's disease and are among the most rapidly acting agents. They act to suppress the cells of the immune system, and the chemicals that can cause inflammation. Corticosteroids are used most often in mild to moderate disease that does not respond to aminosalycilates, and in cases of severe disease, where rapid, effective control is necessary. The intravenous formulations are most helpful in patients who can not tolerate oral intake, or whose disease is so severe that effective delivery of an oral preparation may be in doubt.