Evolving medical therapies for Crohn's disease

Medical therapy for Crohn's disease has changed dramatically over the past few years. Physicians have become increasingly willing to use traditional immunosuppressive agents such as azathioprine/6-mercaptopurine (6-MP) and methotrexate as well as new biologic therapies such as infliximab. Azathioprine, 6-MP, and methotrexate have demonstrated efficacy in induction and maintenance of remission in Crohn's disease. 6-MP has also demonstrated efficacy in the pediatric population and possibly as first-line therapy. As use of the purine metabolites grows, therapeutic drug monitoring for efficacy and toxicity will become an emerging area of interest. With respect to the biologic therapies, infliximab is increasingly used to treat patients with difficult disease; however, knowledge is still evolving regarding optimal dosing schedules and the significance of immune reactions to the compound. A humanized anti-tumor necrosis factor antibody, CDP571, may be less immunogenic. Interleukin-10 did not consistently demonstrate benefit in Crohn's disease. Similarly, antisense to intracellular adhesion molecule 1 (ISIS 2302) was not efficacious when administered either subcutaneously or intravenously. Finally, growth hormone has shown promising results in a small trial.