Medical therapy of Crohn disease

This review will outline the current management of Crohn disease and highlight the knowledge gained from published studies and abstracts in the year 2003.

The year 2003 was highlighted by further knowledge on the use of biologic therapy in Crohn disease. Important lessons were learned from the expanding clinical experience with infliximab. Several other studies of agents targeting tumor necrosis factor-alpha revealed mixed and sometimes disappointing results. However, this was balanced by encouraging results of several studies of biologic agents that inhibit lymphocyte trafficking. Other studies evaluated a variety of small molecules, including tacrolimus, leflutamide, and mycophenolate. Finally, controversy was raised with published studies looking at the efficacy and safety of 6-thiogunaine.

There appears to be an expanding array of treatment options that will become available to clinicians for the treatment of Crohn disease. New treatment paradigms have emerged for managing mild to moderate disease. Small molecules may provide alternatives for immunomodulation other than the purine antimetabolites and methotrexate. Increased understanding of the pathophysiologic mechanisms of Crohn disease has allowed the development of novel therapeutics directed at specific molecular targets. However, as the treatment options expand, questions regarding optimal combination treatment strategies will need to be answered.