Research, trials, and evidence
If you've been living with Crohn's disease for any length of time, you've probably searched some version of "is there a cure for Crohn's?" at least once. The honest answer remains no, not yet. But the treatment landscape is shifting faster than at any point in the disease's history, with several genuinely new mechanisms entering late-stage clinical trials and early research pointing toward approaches that were science fiction a decade ago. Here's what's actually worth paying attention to in 2026.
TL1A Inhibitors: A New Class of Drug With Anti-Fibrotic Potential
The biggest development in the Crohn's pipeline is a new class of biologic drugs targeting a protein called TL1A, or tumor necrosis factor-like cytokine 1A. Unlike existing biologics that primarily address inflammation, TL1A inhibitors show early evidence of also reducing intestinal fibrosis, the scarring that causes strictures and often leads to surgery.
Two TL1A inhibitors are furthest along. Duvakitug, developed by Teva and Sanofi, became the first anti-TL1A antibody to demonstrate efficacy in a placebo-controlled Crohn's disease trial through the RELIEVE Phase 2b study. Tulisokibart, from Merck, showed promising results in a Phase 2a proof-of-concept study and has now advanced to Phase 3 trials. Several other companies are entering the space, including Xencor with XmAb942, which supports dosing intervals as long as 12 weeks.
If Phase 3 results hold up, TL1A inhibitors could become the first treatment to address both the inflammation and the structural damage of Crohn's disease.
IL-23 Inhibitors Are Expanding Options
While TL1A is the new frontier, a more established class of drugs, IL-23 inhibitors, continues to mature. Three IL-23 inhibitors are now approved for Crohn's disease: risankizumab, guselkumab, and mirikizumab. A 2025 systematic review comparing these drugs found that each has distinct strengths: guselkumab for rapid response, mirikizumab for the lowest rate of serious adverse events, and risankizumab for the strongest endoscopic healing with a balanced safety profile.
For patients who have stopped responding to older biologics like anti-TNF drugs, IL-23 inhibitors represent a meaningful second or third line of treatment, with remission rates reaching up to 45% in clinical trials, including among patients who had already failed other biologics.
Stem Cell Therapy for Perianal Fistulas
Perianal fistulas affect roughly a third of Crohn's patients and are notoriously difficult to treat. Mesenchymal stem cell therapy, where stem cells are injected directly into fistula tracts, has accumulated real clinical data. A 2025 meta-analysis of 25 studies involving 596 patients found combined remission rates of 52% at 12 months.
Darvadstrocel, an allogeneic adipose-derived stem cell product, is already approved in Europe and Japan for complex perianal fistulas. The picture is nuanced, though: a follow-up confirmatory trial did not meet its primary endpoint, and real-world data show variable results across centers. This therapy is promising for a specific complication, not a general Crohn's treatment.
Gene Therapy and the NOD2 Connection
About 20 to 40% of Crohn's patients carry mutations in the NOD2 gene, one of the strongest known genetic risk factors. In late 2025, UC San Diego researchers used AI to unravel how the most common NOD2 mutation disrupts immune cell signaling by preventing the NOD2 protein from binding to a protein called girdin, tipping the immune system toward chronic inflammation.
This discovery has opened the door to gene therapy approaches. OTL-104, a hematopoietic stem cell gene therapy, aims to correct NOD2 function in patients with specific mutations. Early preclinical work shows that introducing a normal copy of the gene rescues immune cell function. This is years from becoming a treatment option, but it represents the first serious attempt at addressing one of the root genetic causes of Crohn's.
The MAP Vaccine: Still Unproven, but Moving Forward
The theory that Mycobacterium avium subspecies paratuberculosis, or MAP, plays a causal role in Crohn's disease has been debated for decades. In early 2025, a Phase 1b clinical trial began testing a vaccine using simian adenovirus and poxvirus vectors in patients with active Crohn's. This trial is evaluating safety, tolerability, and immune response rather than clinical outcomes. Previous antibiotic approaches targeting MAP produced mixed results, and no diagnostic test can reliably confirm MAP infection in humans. The vaccine approach is scientifically interesting but still very early-stage.
How to Evaluate and Access Clinical Trials
With this many treatments in development, clinical trials are both a source of hope and a practical treatment option. The Crohn's & Colitis Foundation Clinical Trial Finder and ClinicalTrials.gov are the two best starting points.
When evaluating a trial, consider the phase: Phase 1 trials test safety in small groups, Phase 2 trials measure whether the drug works, and Phase 3 trials confirm efficacy in larger populations. Most of the treatments described here are in Phase 2 or Phase 3, meaning they have already cleared early safety hurdles.
Eligibility for trials typically requires documented diagnosis, specific disease severity scores, and detailed records of prior treatments and current symptoms. Having organized records of your flare patterns, medication history, and lab results makes the screening process significantly smoother, and gives researchers a clear baseline to measure whether a treatment is actually working for you.