What options do we have for induction therapy for Crohn's disease?

The first goal of Crohn's disease treatment is to induce a response. The choice of induction therapy depends on a number of factors. First, disease severity will dictate the level of intensity of treatment. Moderate to severely active Crohn's disease needs to be treated more aggressively than mild disease. Second, it is important to consider the disease distribution, since some medications (e.g. 5-aminosalicylates, budesonide, antibiotics) are more effectively delivered to the small bowel or the colon. Third, prior medications need to be considered. A patient naïve to immunomodulators and anti-TNF agents will be managed very differently from a patient who has already failed two anti-TNF drugs. A fourth critical factor is considering the individual patient. The balance of benefits and risks will depend upon the patient's expected disease course, and how much risk they are at personally for serious adverse events related to treatment. In addition, patients' preferences for treatment need to be addressed since they will choose therapies differently based on their personal experience with symptoms, thresholds for risk taking, and fears about their disease and treatment. The basic armamentarium for induction therapy for Crohn's disease includes: 5-aminosalicylates, antibiotics, budesonide, systemic corticosteroids, thiopurines, methotrexate, and anti-TNF agents. These drugs can be used alone or combined in difference treatment algorithms to optimize therapy. The art of treating the IBD patient is in understanding the options and being able to apply an individualized regimen based upon unique patient and disease factors.