ASCRS Textbook of Colon and Rectal Surgery
Medical Therapy for Crohn’s Disease
Key Concepts
- Antibiotics, probiotics, diets, and fecal transplant do not appear offer clinically significant benefit for treatment of Crohn’s disease.
- Exclusive enteral nutrition is beneficial in children but has not yet be shown to be of benefit in adults.
- 5-Aminosalicylates are widely recognized to have role in treatement of mucosal ulcerative colitis, but have a very limited role in the treatment of CD.
- Budesonide is efficacious for induction of clinical remission for CD patients when compared with placebo.
- Systemic steroids are indicated for induction of remission, but not for maintenance of remission due to its side effects; steroid dependency is an indication for surgery.
- Thiopurine and methotrexate monotherapy is not efficacious for induction of remission, but for maintenance of remission as a steroid-sparing agent; these medications are most commonly used in combination with biologics to decrease immunogenicity to the biologic agent.
- Biologic agents are indicated for induction and maintenance of remission in patients with moderate-to-severe Crohn’s disease.
- Biosimilars present no differences in efficacy or safety compared to their originator compounds and have the advantage of lower cost.
- Therapeutic drug monitoring (TDM) of drug levels and anti-drug antibodies (ADA) allows more precise management of patients with Crohn’s disease.
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Last updated: January 26, 2022
Citation
Smith, Radhika K, and Stefan D Holubar. "Medical Therapy for Crohn’s Disease." ASCRS Textbook of Colon and Rectal Surgery, 2022. ASCRS U, www.ascrsu.com/ascrs/view/ASCRS-Textbook-of-Colon-and-Rectal-Surgery/2285041/all/Medical_Therapy_for_Crohn_s_Disease.
Smith RK, Holubar SD. Medical Therapy for Crohn’s Disease. ASCRS Textbook of Colon and Rectal Surgery. 2022. https://www.ascrsu.com/ascrs/view/ASCRS-Textbook-of-Colon-and-Rectal-Surgery/2285041/all/Medical_Therapy_for_Crohn_s_Disease. Accessed June 4, 2023.
Smith, R. K., & Holubar, S. D. (2022). Medical Therapy for Crohn’s Disease. In ASCRS Textbook of Colon and Rectal Surgery https://www.ascrsu.com/ascrs/view/ASCRS-Textbook-of-Colon-and-Rectal-Surgery/2285041/all/Medical_Therapy_for_Crohn_s_Disease
Smith RK, Holubar SD. Medical Therapy for Crohn’s Disease [Internet]. In: ASCRS Textbook of Colon and Rectal Surgery. ; 2022. [cited 2023 June 04]. Available from: https://www.ascrsu.com/ascrs/view/ASCRS-Textbook-of-Colon-and-Rectal-Surgery/2285041/all/Medical_Therapy_for_Crohn_s_Disease.
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