Medical management of Crohn's disease.

Abstract

INTRODUCTION:

The medical approach to Crohn's disease has been modified in recent years thanks to the introduction of new therapies, like biologics. Also, well-designed studies and systematic reviews have allowed better evaluation of the role of old drugs like steroids and immunosuppressors. This review aims to evaluate the recent evidence on the medical approach to Crohn's disease in the different settings of the disease.

AREAS COVERED:

Randomized controlled trials and meta-analyses were included in the review. The research on all the studies discussed was based on the Cochrane Library, Medline and Embase, using the following medical subject headings: Crohn's disease, clinical trial, therapy, 5-aminosalicylic acid, steroid, budesonide, immunosuppressant, anti-meta-analysis TNF and biologics.

EXPERT OPINION:

In a mild active inflammatory ileocecal disease, budesonide is considered the best approach. The efficacy of aminosalicylates is limited, but a trial that has recently compared aminosalicylates and budesonide has shown that the two drugs are comparable. In a mild colonic disease, sulfasalazine, antibiotics and steroids are effective but the evidence for antibiotics is less clear. The maintenance of remission in this setting is debatable, but sulfasalazine seems the better choice. In a moderate severe ileal and colonic disease, steroids are the best therapy to induce remission. Once remission is reached, immunosuppressors remain today the better choice to maintain the remission. Anti-TNF therapy is indicated in patients intolerant or not responding to steroids and immunosuppressors and in fistulizing Crohn's disease. Early therapy with biologics may be considered in patients with severe disease.

• Authors: Mario Cottone, Sara Renna, Ambrogio Orlando, Filippo Mocciaro
• Journal: Expert opinion on pharmacotherapy (Expert Opin Pharmacother) Vol. 12 Issue 16 Pg. 2505-25 (Nov 2011) ISSN: 1744-7666 [Electronic] England
• PMID: 21988215 (Publication Type: Journal Article, Review)

Chemical References

• Adrenal Cortex Hormones
• Aminosalicylic Acids
• Anti-Bacterial Agents
• Anti-Inflammatory Agents
• Biological Products
• Immunosuppressive Agents
• Purines
• Tumor Necrosis Factor-alpha
• Budesonide
• Methotrexate

Topics

• Adrenal Cortex Hormones (therapeutic use)
• Aminosalicylic Acids (therapeutic use)
• Anti-Bacterial Agents (therapeutic use)
• Anti-Inflammatory Agents (therapeutic use)
• Biological Products (therapeutic use)
• Bone Marrow Transplantation
• Budesonide (therapeutic use)
• Crohn Disease (drug therapy, surgery)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Intestines (surgery)
• Methotrexate (therapeutic use)
• Purines (therapeutic use)
• Remission Induction
• Treatment Outcome
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)