Current treatment modalities in active Crohn's disease

Area of Science:

• Gastroenterology
• Internal Medicine
• Pharmacology

Background:

• The exact cause of Crohn's disease remains unknown, necessitating diverse treatment approaches.
• Patient response to Crohn's disease therapy is influenced by disease characteristics, host factors, treatment goals, and drug properties.

Purpose of the Study:

• To review current treatment modalities for active Crohn's disease.
• To compare the efficacy of various drugs, including corticosteroids, immunosuppressives, antibiotics, and budesonide.
• To outline alternative management strategies for refractory or steroid-dependent Crohn's disease.

Main Methods:

• Literature review of available drugs for active Crohn's disease.
• Comparison of remission induction rates for corticosteroids, salicylates, and 5-aminosalicylic acid.
• Evaluation of immunosuppressives, antibiotics, and budesonide in steroid-refractory or specific Crohn's disease types.
• Consideration of surgical resection and supportive therapies like bowel rest and enteral feeding.

Main Results:

• Corticosteroids (65-85% remission) are more effective than sulphasalazine (12%) and 5-aminosalicylic acid (25%) for active Crohn's disease.
• Immunosuppressives show lower efficacy but offer steroid-sparing effects and fistula closure.
• Antibiotics are effective for perianal/colonic disease, and budesonide is comparable to prednisone for small bowel Crohn's disease.

Conclusions:

• Conventional corticosteroids remain the most effective treatment for active Crohn's disease.
• For refractory disease, steroid dependence, or side effects, alternative strategies include surgery for localized disease or alternative medications for extensive/recurrent disease.