Randomized controlled trials in active luminal Crohn's disease.

Area of Science:

• Gastroenterology
• Internal Medicine
• Clinical Therapeutics

Background:

• Numerous clinical trials have investigated treatments for active luminal Crohn's disease (CD).
• A critical review of existing literature is necessary to guide therapeutic decisions.

Purpose of the Study:

• To re-evaluate the efficacy of various treatment options for active luminal Crohn's disease.
• To provide evidence-based recommendations for clinical practice.

Main Methods:

• Systematic review and critical re-evaluation of published clinical trials.
• Analysis of evidence for 5-ASA derivatives, conventional steroids, antibiotics, immunosuppressors, and anti-TNF alpha agents.

Main Results:

• 5-ASA derivatives demonstrate no significant benefit over placebo for active CD.
• Conventional steroids, based on fundamental Cooperative studies, remain a key evidence base.
• Antibiotics lack support as a primary strategy due to conflicting results.
• Methotrexate shows potential for remission induction, while azathioprine/6-MP are not recommended for induction.
• Anti-TNF alpha agents (infliximab, adalimumab) are effective but require further safety and economic evaluation.

Conclusions:

• Current guidelines suggest 5-ASA and antibiotics are not effective for active luminal CD.
• Methotrexate and anti-TNF alpha agents represent viable options for inducing remission in active CD.
• Further research is needed to optimize the use of anti-TNF alpha agents considering safety and cost-effectiveness.