Perspective: Making Treatment Decisions for Crohn's Disease in 2025-Key Considerations

The treatment algorithm for Crohn's disease evolves over time. In this review article we highlight nine studies from the last decade that have influenced our thinking on the treatment of Crohn's disease. This perspective is a narrative, opinion-based review and reflects our personal thinking on some aspects of the treatment of Crohn's disease. We selected original studies that have influenced our thoughts on luminal Crohn's disease treatment significantly. Moderate to severe Crohn's disease should be treated appropriately from diagnosis with advanced therapy or surgery in select cases of limited ileal disease. Close observation may be sufficient for mild cases. Small intra-abdominal abscesses can be treated without surgery in some cases and a cooperative multi-disciplinary team working approach with radiology, surgery and dietitians is key. Anti-TNF therapy provides effective and relatively inexpensive first-line treatment but requires careful therapeutic monitoring and/or immunomodulator co-therapy to avoid immunogenicity. Those achieving remission at 1 year very often maintain this long-term. For those experiencing non-response or loss of response to anti-TNF therapy, ustekinumab or risankizumab offer appropriate second-line treatments. Biomarkers to better guide treatment decisions are urgently needed. Dietary approaches to the management of Crohn's disease are currently evolving and may provide a future disease-modifying avenue.