Maintenance of medically induced remission of Crohn's disease

The natural history of Crohn's disease is characterized by recurring flares alternating with periods of inactive disease and remission. This implies that most patients need to take medication for a large period of their life, mostly for maintenance of remission and, intermittently, additional therapy during a flare. Low-dose systemic corticosteroids are not effective in maintaining remission and should not be used for this indication. There is a trend towards a prolonged time to relapse in patients in remission who are treated with budenoside, a corticosteroid with high topical anti-inflammatory activity and low systemic activity. Azathioprine and 6-mercaptopurine are effective in maintaining remission. Maintenance benefits remain significant for patients who continued with the therapy for up to 5 years. Methotrexate has also been found to be effective in maintaining remission in Crohn's disease in patients who have responded acutely to methotrexate. Cyclosporine has not been found to be an effective maintenance agent. Only a few studies in small numbers of patients have been published on the use of tacrolimus. There is a lack of convincing evidence of efficacy of mycophenolate mofetil. The use of anti-TNF agents may change the future approach to maintenance therapy for Crohn's disease. Patients who responded clinically to infliximab, adalimumab and certolizumab have maintained their clinical response when receiving repeat infusions or subcutaneous injections, respectively. In patients refractory to other therapies, infliximab may be effective in maintaining remission.