Advances in medical therapy for Crohn’s disease (original) (raw)

4 Medical therapy of active Crohn's disease

Baillière's Clinical Gastroenterology, 1998

Active Crohn's disease constitutes a major problem in gastroenterology. Symptoms vary with site, extent and local complications of the disease as well as with the absence or presence of extraintestinal manifestations. Due to the troublesome consequences of the disease new treatments have continuously been tried. However, the results have varied and no definite breakthrough has occurred in the medical treatment of active Crohn's disease during the last years. The new salicylates have shown some effect using higher doses, but have not fulfilled the expectations once connected with their development. The new steroids have compared well to, but not exceeded, the older corticosteroid preparations in terms of therapeutic efficacy but they have a better side-effect profile. The role of the purine analogs azathioprine/6-mercaptopurine has been further evaluated. The onset of their effect is slow, an intravenous loading dose might shorten this time span, and they are steroid sparing. The controlled data on methotrexate are limited and the long-term effects not well studied and there is concern about toxicity. Even the use of cyclosporine in active Crohn's disease is controversial and connected with serious adverse events. Studies on the new immune modulating therapies such as anti-TNF-cx antibodies, anti-CD4 antibodies, interleukin-10 and interferon have been encouraging but large scale studies are still awaited before the effect and the spectra of side-effects can be fully evaluated.

THERAPIES FOR CROHN'S DISEASE: a clinical update

Arquivos de Gastroenterologia, 2016

The main objectives of clinical therapy in Crohn's disease are clinical and endoscopic remission without the use of corticosteroids for long periods of time, prevention of hospitalization and surgery, and improvement of quality of life. The main limitation of drug therapy is the loss of response over the long term, which makes incorporation of new drugs to the therapeutic arsenal necessary. This review analyses the main drugs currently used in clinical treatment of Crohn's disease.

Evidence-based treatment algorithm for mild to moderate Crohn's disease

The American journal of gastroenterology, 2003

Therapies demonstrated to be effective in randomized, controlled trials for induction of remission in patients with mildly to moderately active Crohn's disease include sulfasalazine, budesonide, and oral corticosteroids administered for 8 -16 wk. Patients who relapse within 6 -12 months after discontinuation of induction therapy should be treated with another cycle of induction therapy and then receive maintenance therapy with an immunosuppressive agent (azathioprine, 6-mercaptopurine, or methotrexate). Long term treatment with budesonide 6 -9 mg q.d. might be an alternative to immunosuppressive maintenance therapy in patients who relapse within 6 -12 months after discontinuation and in prednisone-dependent patients. (Am J Gastroenterol 2003;98:S1-S5.

Crohn’s disease - treatment with biological medication

Revista da Associação Médica Brasileira

1. Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 -10 0 Andar -Jardim Paulistano, São Paulo -SP, Brasil 2. Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 -10 0 Andar -Jardim Paulistano, São Paulo -SP, Brasil 3. Brazilian Coloproctology Society, Avenida Marechal Câmara, 160 sala 916 -Centro, Rio de Janeiro -RJ, Brasil http://dx.doi.org/10.1590/1806-9282.65.4.554

Role of conventional therapies in the era of biological treatment in Crohn’s disease

World Journal of Gastroenterology, 2011

Outstanding progress regarding the pathophysiology of Crohn's disease (CD) has led to the development of innovative therapeutic concepts. Numerous controlled trials have been performed in CD. This review concentrates on the results of randomized, placebo-controlled trials, and meta-analyses when available, that provide the highest degree of evidence. Current guidelines on the management of CD recommend a step-up approach to treatment involving the addition of more powerful therapies as the severity of disease and refractoriness to therapy increase. The advent of biological drugs has opened new therapeutic horizons for treating CD, modifying the treatment goals. However, the large majority of patients with CD will be managed through conventional therapy, even if they are a prelude to biological therapy.