What is the treatment approach for Crohn's disease?

From the Guidelines

The treatment approach for Crohn's disease involves a multifaceted strategy tailored to the individual's disease severity, location, and complications, with biologic agents such as anti-TNF medications being first-line biologics for moderate to severe disease. The initial therapy typically includes anti-inflammatory medications such as aminosalicylates (mesalamine 2-4g daily) for mild disease, corticosteroids (prednisone 40-60mg daily with tapering) for moderate to severe flares, and immunomodulators like azathioprine (2-3mg/kg/day) or methotrexate (15-25mg weekly) for maintenance therapy 1.

Key Treatment Components

• Biologic agents: anti-TNF medications (infliximab 5mg/kg at weeks 0,2,6, then every 8 weeks; adalimumab 160mg initially, 80mg at week 2, then 40mg every 2 weeks) are recommended for patients with moderate to severe inflammatory Crohn’s disease who have failed to achieve clinical remission with corticosteroids 1
• Immunomodulator therapy: azathioprine, mercaptopurine, or methotrexate are effective in maintaining remission of Crohn’s disease 1
• Nutritional support: exclusive enteral nutrition may be an effective therapy for induction of clinical remission and endoscopic response in mild to moderate Crohn’s disease of relatively short duration 1
• Surgery: becomes necessary for complications like strictures, fistulas, or abscesses that don't respond to medical therapy

Additional Considerations

• The treatment goal is to achieve and maintain remission, heal the intestinal mucosa, prevent complications, and improve quality of life
• A Mediterranean diet rich in fresh fruits and vegetables, monounsaturated fats, complex carbohydrates, and lean proteins, and low in ultraprocessed foods, added sugar, and salt is recommended for overall health and general well-being 1
• Regular screening for malnutrition is essential, and nutritional support should be individualized based on patient needs 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. 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 treatment approach for Crohn's disease includes the use of infliximab (IV), specifically RENFLEXIS, which is indicated for:

• Reducing signs and symptoms
• Inducing and maintaining clinical remission
• Reducing the number of draining enterocutaneous and rectovaginal fistulas and maintaining fistula closure The recommended dose 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 2.

Key points:

• Infliximab products should be used with caution in patients with chronic or recurrent infection.
• Patients should be closely monitored for the development of signs and symptoms of infection during and after treatment with RENFLEXIS.
• Live vaccines should not be given concurrently with RENFLEXIS or to infants after in utero exposure to infliximab products for at least 6 months following birth 2.

From the Research

Treatment Approach for Crohn's Disease

The treatment approach for Crohn's disease involves inducing and maintaining remission of symptoms. The goal is to control inflammation and prevent long-term complications.

• Induction of remission:
  • Sulfasalazine, budesonide, and conventional corticosteroids are effective for inducing remission of mild-to-moderate Crohn's disease 3.
  • Infliximab is indicated for treatment of signs and symptoms, and induction and maintenance of remission in patients with moderate to severely active inflammatory Crohn's disease 4.
  • Budesonide is recommended for induction of remission in ambulatory outpatients with low-risk, mild, ileal or ileocolonic CD 5.
• Maintenance of remission:
  • Selection of maintenance therapy is based on a combination of evidence from controlled trials and patient features including disease severity and location, co-morbidities, previous response to treatment, and previous surgical resection 3.
  • Azathioprine, 6-mercaptopurine, or methotrexate may be used for maintenance therapy 3, 4.
  • Infliximab + azathioprine, adalimumab, and vedolizumab were superior to placebo for maintaining remission 6.
  • Adalimumab and infliximab + azathioprine are the most effective therapies for induction and maintenance of remission of Crohn's disease 6.

Treatment Options

• Biologics:
  • Infliximab, adalimumab, certolizumab, and vedolizumab are biologic agents used to treat Crohn's disease 4, 6.
  • Monoclonal antibodies to IL-12/23 or integrin α4β7 are also used 7.
• Immunomodulators:
  • Azathioprine, 6-mercaptopurine, and methotrexate are immunomodulators used to treat Crohn's disease 3, 4, 6.
• Combination therapies:
  • Combination of infliximab and azathioprine is effective for induction and maintenance of remission 6.

Patient Management

• Patient risk stratification, patient preference, and clinical factors are important in therapeutic decision-making 7.
• Vaccinations to prevent infections are important components of health maintenance for patients with Crohn's disease 7.
• Physicians should be familiar with the advantages and disadvantages of each therapy to best counsel their patients 7.