Medical Therapy for Crohn’s Disease

Radhika K. Smith, Stefan D. Holubar

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