From the Guidelines
Treatment for an active Crohn's disease flare should prioritize the use of biologic agents, such as infliximab or adalimumab, with or without an immunomodulator, as first-line therapy to induce and maintain clinical remission, as recommended by the AGA clinical practice guidelines 1. The goal of treatment is to reduce inflammation, control symptoms, and improve quality of life.
- For mild flares, corticosteroids such as prednisone (40-60mg daily, tapered over 8-12 weeks) or budesonide (9mg daily for 8-12 weeks) may be used to quickly reduce inflammation 1.
- Immunomodulators such as azathioprine (2-3mg/kg/day), 6-mercaptopurine (1-1.5mg/kg/day), or methotrexate (25mg weekly) may be used for moderate to severe flares, though these work more slowly over weeks to months 1.
- Biologic agents like infliximab (5mg/kg IV at weeks 0,2, and 6, then every 8 weeks), adalimumab (160mg initially, 80mg at week 2, then 40mg every other week), or ustekinumab can provide rapid relief for severe flares 1. During flares, patients should:
- Maintain adequate hydration
- Consider a low-residue diet to reduce bowel irritation
- Avoid NSAIDs which can worsen symptoms Antibiotics like ciprofloxacin or metronidazole may be prescribed if infection is suspected. These medications work by suppressing the abnormal immune response that causes intestinal inflammation, allowing the bowel to heal and reducing symptoms like diarrhea, abdominal pain, and bleeding. The use of biologic agents as first-line therapy is supported by recent guidelines, which suggest that early introduction of these agents can result in better outcomes and reduced risk of disease progression 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 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 HUMIRA is indicated for: treatment of moderately to severely active Crohn’s disease in adults and pediatric patients 6 years of age and older. Adults: 160 mg on Day 1 (given in one day or split over two consecutive days); 80 mg on Day 15; and 40 mg every other week starting on Day 29
The treatment for an active Crohn's flare is induction and maintenance therapy with medications such as:
- Infliximab (IV): 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 2
- Adalimumab (SQ): 160 mg on Day 1,80 mg on Day 15, and 40 mg every other week starting on Day 29 3 Key points:
- These medications are indicated for reducing signs and symptoms and inducing and maintaining clinical remission in adult patients with moderately to severely active Crohn's disease.
- The dosage and administration may vary depending on the patient's response and medical history.
From the Research
Treatment Options for Active Crohn's Flare
The treatment for an active Crohn's flare typically involves a combination of medications and lifestyle changes. The goal of treatment is to reduce inflammation, manage symptoms, and induce remission.
- Medications:
- Aminosalicylates, such as sulfasalazine, may be used to induce remission in patients with mild to moderately active Crohn's disease 4.
- Corticosteroids, such as budesonide, are effective in inducing remission in patients with active Crohn's disease 5, 4.
- Biologics, such as infliximab, adalimumab, and vedolizumab, are effective in inducing and maintaining remission in patients with moderate to severe Crohn's disease 6, 7.
- Immunomodulators, such as azathioprine, may be used to maintain remission in patients with Crohn's disease 5, 6.
- Lifestyle Changes:
- Dietary changes, such as a Crohn's Disease Exclusion Diet, may be recommended to help manage symptoms and induce remission 5.
- Stress management techniques, such as meditation and yoga, may be recommended to help manage stress and reduce symptoms.
- Surgery:
- Surgery may be necessary in some cases to remove damaged portions of the intestine or to treat complications such as bowel obstruction or fistulas 6.
Factors Influencing Treatment Choice
The choice of treatment for an active Crohn's flare depends on several factors, including:
- Disease Severity: Patients with mild disease may be treated with aminosalicylates or corticosteroids, while those with moderate to severe disease may require biologics or immunomodulators 5, 6.
- Patient Preferences: Patients may have preferences for certain treatments based on their lifestyle, medical history, and personal values.
- Clinical Factors: Clinical factors, such as the presence of complications or comorbidities, may influence the choice of treatment 6.
Ongoing Research and Future Directions
Ongoing research is focused on developing new treatments for Crohn's disease, including novel biologics and small molecules 5, 8. Additionally, research is being conducted to better understand the underlying causes of Crohn's disease and to develop more effective treatment strategies 5, 6.