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"Pentasa is useless for Crohn's" -- then why is it so prescribed?

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Crohn's Disease
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Posted 3/7/2018 4:21 AM (GMT 0)
Everyone on here keeps saying pentasa is worthless for crohns--so why do so many doctors give it out? What am I missing?
Posted 3/7/2018 6:33 AM (GMT 0)
Pentasa is used a lot in UC so sometimes if the Crohn’s medication isn’t working then they’ll try something like pentasa to see if it is maybe UC instead. That’s usually only if it is in the colon though. They do the same for UC people as well... even though the medications for UC and Crohn’s are basically the same, they work differently sometimes. This is just based off of what I’ve heard though so it could be wrong!
Posted 3/7/2018 7:20 AM (GMT 0)
You have read in the archives here in the crohns forum apparently about Pentasa not working for crohns. Of course we can't answer why your dr. UC folks have success with it but crohns people as a rule do not. Perhaps he treats more UC people, I really do not know. If its not working for you I would let him know.
Posted 3/7/2018 2:06 PM (GMT 0)
Pentasa is a topical medication that effectively treats shallow-inflammation involving the top-most layers of intestinal tissue. UC is shallow-inflammation involving the top most layers of intestinal tissue, a good match for it, and used widely for UC patients. Crohn's is deep-inflammation that often goes much, much further into the intestinal tissue and therefore Pentasa might only partially treat it. I would hope that when prescribing pentasa to Crohn's patients that doctors are choosing those patients with the mildest cases who present shallower-inflammation rather than those with more severe inflammation that goes deeper. Biopsy results would identify the depth of inflammation, so it would be a known factor to your gasteroenteroligist at the time he/she prescribes you medication to treat your Crohn's. Maybe selective usage with Crohn's has an affect for mild cases? It at least seems plausible. I'll defer to those who know more and have Crohn's themselves on that point (I have UC).
Posted 3/7/2018 4:50 PM (GMT 0)
I think older studies suggested mesalazine (which Pentasa is) was more effective for Crohn's than more recent studies have shown it to be. Also, there was/is an assumption that if mesalazine worked for UC, then it should work for Crohn's too - but iPoop's post explains why that assumption is wrong.

However I think the main reason why docs still use Pentasa for Crohn's is that there nothing else out there for mild Crohn's and perhaps it may help. In about 30% of cases with Crohn's the disease will continue on a mild pathway, and going on a biologic would be overkill for that subset of patients. The problem is knowing in advance which mild cases will go on to get worse and which won't - if we knew that, we could target the mild-to-severe cases in advance with stronger meds, but we don't.
Posted 3/7/2018 7:37 PM (GMT 0)
From my Dr’s perspective, he said insurance companies want proof that other drugs have been tried & failed prior to authorizing treatment/payment for biologics. And along those lines, since everyone responds to meds differently, it makes sense to start with lower risk drugs on the off chance it may be effective for you?

Good luck to you, and all.
Posted 3/7/2018 8:28 PM (GMT 0)
yes, some times its because of insurance, some times its because the doctor is not up on current research and still ascribes to the old "bottom up " versus "top down" treatment plan.It may be helpful for those with mild disease. It may also be used for those who are against taking the more potent meds since its worth trying to see if it makes a difference even if its unlikely. I was on it in the beginning for a little while and it did help some ares in my colon i believe but not further up. when I had a very small but stubborn to heal area in my colon more recently the doctor added it to my list which already includes remicade and 6mp, to see if it could make a difference. It was worth trying. not sure if thats what did it but last time it was checked there was no sign of it and I don't take it anymore.
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