From the Guidelines
The most effective treatment for a Crohn's disease flare-up is the early introduction of biologic agents, such as anti-TNF medications, with or without an immunomodulator, as recommended by the AGA clinical practice guidelines 1. This approach is supported by several studies, including the REACT study, which showed that early combination therapy with an immunomodulator and biologic drug reduced the risk of major adverse disease-related complications compared to conventional management 1. The treatment plan may include:
- Oral corticosteroids, such as prednisone (typically 40mg daily, tapered over 8-12 weeks) or budesonide (9mg daily for 8-12 weeks), to quickly reduce inflammation
- Immunomodulators, such as azathioprine (2-3mg/kg/day) or 6-mercaptopurine (1-1.5mg/kg/day), which work more slowly
- Biologic agents, including anti-TNF medications (infliximab, adalimumab, certolizumab pegol), anti-integrin therapies (vedolizumab), or IL-12/23 inhibitors (ustekinumab), which are often necessary for severe flares or steroid-dependent disease
- Exclusive enteral nutrition (EEN) or a Crohn’s disease exclusion diet, which may be effective for induction of clinical remission and endoscopic response in mild to moderate Crohn’s disease of relatively short duration 1
- Pain management with acetaminophen, and antibiotics like ciprofloxacin or metronidazole if infection is suspected
- Maintenance of adequate hydration, a low-residue diet to reduce bowel irritation, and avoidance of NSAIDs, which can worsen symptoms. It is essential to note that the treatment plan should be individualized based on the severity of the flare-up, disease location, and patient response to previous treatments, as recommended by the British Society of Gastroenterology consensus guidelines 1.
From the FDA Drug Label
RENFLEXIS is indicated for reducing signs and symptoms and inducing and maintaining clinical remission in adult patients with moderately to severely active Crohn's disease who have had an inadequate response to conventional therapy RENFLEXIS is indicated for reducing the number of draining enterocutaneous and rectovaginal fistulas and maintaining fistula closure in adult patients with fistulizing Crohn's disease. HUMIRA is used: To treat moderate to severe Crohn’s disease (CD) in adults and children 6 years of age and older.
Treatment for Crohn's Disease Flare-up:
- Infliximab (IV) 2 and adalimumab (SQ) 3 are indicated for reducing signs and symptoms and inducing and maintaining clinical remission in adult patients with moderately to severely active Crohn's disease.
- These medications can be used to treat Crohn's disease flare-ups in adults and children 6 years of age and older.
- It is essential to closely monitor patients and have regular follow-up visits with a physician when using these medications.
From the Research
Treatment Options for Crohn's Disease Flare-up
- Corticosteroids, high-dose budesonide, and high-dose mesalamine are effective treatments for inducing remission in mild-to-moderate Crohn's disease 4, 5
- Sulfasalazine may be an option for patients with disease limited to the colon 6
- Mesalamine has a clear role in the maintenance of remission in ulcerative colitis, but its benefits in the management of acute Crohn's disease and the maintenance of remission are questionable 7
- A controlled-release mesalamine preparation is safe and effective at 4 g/day as a single agent in the treatment of active Crohn's disease of the ileum and colon 8
Induction of Remission
- Corticosteroids and high-dose budesonide were found to be effective treatments for inducing remission in mild-to-moderate Crohn's disease 4, 5
- High-dose mesalamine may be an option among patients preferring to avoid steroids 4, 5
- Budesonide 9 mg/day may be used to induce remission in patients with ileal and/or right colonic involvement 6