From the Guidelines
The recommended approach for Crohn's disease involves a comprehensive evaluation, including a detailed medical history, physical examination, laboratory tests, and imaging studies, followed by targeted treatment based on disease severity, location, and complications, with a focus on minimizing morbidity, mortality, and improving quality of life 1.
Evaluation
The evaluation of Crohn's disease should include:
- A detailed medical history and physical examination
- Laboratory tests, such as complete blood count, inflammatory markers (e.g., C-reactive protein and erythrocyte sedimentation rate), stool studies to rule out infections, and imaging studies (e.g., CT or MRI enterography) 1
- Endoscopic evaluation with colonoscopy and upper endoscopy with biopsies to confirm diagnosis and assess disease extent 1
Treatment
Treatment for Crohn's disease follows a step-up approach based on disease severity, location, and complications:
- For mild to moderate disease, first-line medications include aminosalicylates (e.g., mesalamine, 2-4g daily) and budesonide (9mg daily for 8-12 weeks) 1
- For moderate to severe disease, systemic corticosteroids (e.g., prednisone, 40-60mg daily with taper over 8-12 weeks) may be used for acute flares, while immunomodulators (e.g., azathioprine, 2-3mg/kg/day; 6-mercaptopurine, 1-1.5mg/kg/day; or methotrexate, 15-25mg weekly) are used for maintenance 1
- Biologic agents, including anti-TNF agents (e.g., infliximab, adalimumab, certolizumab pegol), anti-integrin therapies (e.g., vedolizumab), and IL-12/23 inhibitors (e.g., ustekinumab), are increasingly used earlier in treatment for moderate to severe disease 1
Monitoring
Monitoring for patients with Crohn's disease should include:
- Regular assessment of symptoms using standardized tools (e.g., Crohn's Disease Activity Index or Harvey-Bradshaw Index) 1
- Endoscopic evaluation to assess disease activity and extent 1
- Laboratory tests to monitor inflammatory markers, complete blood count, and liver function 1
- Imaging studies to assess disease extent and complications 1 The goal of treatment is to induce and maintain remission, minimize complications, and improve quality of life, with a focus on individualized care based on disease severity, location, and patient response to treatment 1.
From the FDA Drug Label
- 1 Crohn's Disease 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 The recommended dose of RENFLEXIS is 5 mg/kg given as an intravenous induction regimen at 0,2 and 6 weeks followed by a maintenance regimen of 5 mg/kg every 8 weeks thereafter for the treatment of adults with moderately to severely active Crohn's disease or fistulizing Crohn's disease
The recommended evaluation and treatment approach for Crohn's disease includes:
- 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.
- The treatment regimen consists of an intravenous induction regimen of 5 mg/kg at 0,2, and 6 weeks, followed by a maintenance regimen of 5 mg/kg every 8 weeks.
- For patients who respond and then lose their response, consideration may be given to treatment with 10 mg/kg.
- Patients who do not respond by Week 14 are unlikely to respond with continued dosing and consideration should be given to discontinue treatment 2.
From the Research
Evaluation of Crohn's Disease
The evaluation of Crohn's disease involves a combination of clinical assessment, laboratory tests, and imaging studies.
- Clinical assessment: Patients with Crohn's disease may experience symptoms such as diarrhea, abdominal pain, fever, weight loss, abdominal masses, and anemia 3.
- Laboratory tests: Acute phase reactants, such as C-reactive protein level and erythrocyte sedimentation rate, are often increased with inflammation and may correlate with disease activity 3, 4, 5.
- Imaging studies: Colonoscopy with ileoscopy, capsule endoscopy, computed tomography enterography, and small bowel follow-through are often used to diagnose Crohn's disease 3, 6.
Treatment Approach
The treatment approach for Crohn's disease depends on the severity of the disease and the presence of extraintestinal manifestations.
- Mild to moderate colonic Crohn's disease: Mesalamine products are often used for the medical management of mild to moderate colonic Crohn's disease 3.
- Moderate to severe Crohn's disease: Patients with moderate to severe Crohn's disease are treated with corticosteroids, azathioprine, 6-mercaptopurine, or anti-tumor necrosis factor agents (e.g., infliximab, adalimumab) 3, 7.
- Severe disease: Severe disease may require emergent hospitalization and a multidisciplinary approach with a family physician, gastroenterologist, and surgeon 3.
Disease Activity Assessment
Disease activity in Crohn's disease can be assessed using various markers, including C-reactive protein level and fecal calprotectin.
- C-reactive protein level: The C-reactive protein level is correlated to disease activity in Crohn's disease and can be used to predict moderate and severe disease activity 4, 5.
- Fecal calprotectin: Measurement of fecal calprotectin has value to rule out disease in adults and children and can be used to assess disease activity 7.