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DEAR DR. ROACH: I’m a 57-year-old man, and I’ve had Crohn’s disease since I was a child. For the past 18 years, I’ve managed it quite successfully with 6-MP, budesonide and Xifaxan. For the past five years in particular, I’ve been in perfect health. My C-reactive protein (CRP) test was under 5 mg/dL, and my colonoscopy from about four years ago was pristine.
Just recently, I had a colonoscopy that showed significant inflammation, and my blood work is showing it, too, with a CRP of 19.5 mg/dL. My doctor recommends an aggressive treatment with Skyrizi. I don’t want to take this because I’m not having any pain at all. However, I’ve lost about 10 pounds in the past few weeks.
Would you recommend a more aggressive course? I feel that a very careful diet might get my disease under control without more medication. -- M.O.
ANSWER: Your doctor is recommending the current standard of care. Even though you’re feeling well, there’s clear evidence that your Crohn’s disease is active, despite your current regimen that has worked well for you for years. The endoscopy showing inflammation is important, as the current recommendation is that there shouldn’t be any evidence of the active disease through an endoscopy. (Your doctor should be sure that there isn’t an infection first, such as Clostridioides difficile.)
The high level of CRP confirms diffuse inflammation, and I worry that your weight loss means that your intestines are having a hard time absorbing food. The current guidelines from expert groups recommend escalating therapy, and there are several classes of biological therapies available. Your doctor is recommending risankizumab (Skyrizi), which blocks the IL-23 receptor and suppresses the inflammatory and immune responses that are overactive in people with Crohn’s disease. Of the available treatments, this one has a good combination of effectiveness and safety.
I can understand why you’re hesitant to start a potent agent, even one that is relatively safe. All medications in this class of treatments have the potential for side effects, with respiratory infections (colds), headaches, and joint aches being among the most common with Skyrizi. Less than 4% of people had to discontinue the medication due to side effects. Fortunately, the rate of severe infections is very low with this class of agents compared to other biological therapies.
The goal of treatment is to prevent complications from Crohn’s disease, and if the disease progresses without therapy, there’s a risk of strictures (partial blockages in the bowel) and fistulae (abnormal connections between the bowel and other organs). My time of taking care of people with inflammatory bowel disease was from a time before highly effective therapy was available, and I wouldn’t wish those complications on anyone.
Long-term treatment with Skyrizi showed that up to 75% of people — most of whom had resistant disease — reached clinical remission. While this isn’t perfect, considering the safety of the medication, I’d absolutely support the decision if one of my patients were recommended Skyrizi by their gastroenterologist.
You could discuss a dietary trial with your gastroenterologist. You’ve had decades of experience with your disease, and I respect your concerns. However, I’d make the dietary trial time-limited. If the blood tests and endoscopy don’t showing a clear improvement after the trial, I’d strongly recommend treatment with a highly effective but relatively safe agent, such as the one that your gastroenterologist recommends.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc.
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