From the Guidelines
The treatment for an acute Crohn's flare typically involves a combination of anti-inflammatory medications and supportive care, with early introduction of biologics with or without an immunomodulator recommended for moderate to severe disease, as suggested by the AGA clinical practice guidelines 1. For mild to moderate flares, oral corticosteroids like prednisone (40-60mg daily, tapered over 8-12 weeks) are often the first-line treatment to rapidly reduce inflammation.
- Aminosalicylates such as mesalamine (2-4g daily) may be used for colonic disease.
- For moderate to severe flares, stronger immunosuppressants may be needed, including biologics 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 (initial IV dose based on weight, followed by 90mg subcutaneous injections every 8 weeks).
- Antibiotics like metronidazole (10-20mg/kg/day) or ciprofloxacin (500mg twice daily) are used if infection is suspected or for perianal disease. Supportive care includes:
- Adequate hydration
- Nutritional support
- Pain management with acetaminophen or, if necessary, opioids
- Anti-diarrheals like loperamide for symptom control These medications work by suppressing the abnormal immune response that causes intestinal inflammation. Hospitalization may be required for severe flares with dehydration, significant pain, or complications. Once the flare is controlled, maintenance therapy will be needed to prevent future flares, with immunomodulators such as azathioprine, mercaptopurine or methotrexate effective in maintaining remission of Crohn’s disease 1.
From the FDA Drug Label
Crohn’s Disease (CD) (1.5): treatment of moderately to severely active Crohn’s disease in adults and pediatric patients 6 years of age and older.
DOSAGE AND ADMINISTRATION Crohn's Disease (2. 3): 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 acute Crohn's flare is adalimumab (SQ) with a dosage of:
- 160 mg on Day 1 (given in one day or split over two consecutive days)
- 80 mg on Day 15
- 40 mg every other week starting on Day 29 2
From the Research
Treatment Options for Acute Crohn's Flare
The treatment for an acute Crohn's flare typically involves the use of medications to reduce inflammation and manage symptoms.
- Aminosalicylates, such as mesalamine, have been shown to be effective in inducing remission in patients with mild to moderate Crohn's disease 3, 4, 5, 6.
- Corticosteroids, such as 6-methylprednisolone, may also be used to induce remission in patients with acute Crohn's flares 3.
- The use of mesalamine in microgranular formulation has been shown to be equally as effective as a standard dosage of steroids in the treatment of mild to moderate Crohn's ileitis 3.
- High-dose mesalamine (3 to 4.5 g/day) has been found to be not more effective than placebo for inducing response or remission in patients with mildly to moderately active Crohn's disease 4.
Considerations for Treatment
When considering treatment options for an acute Crohn's flare, it is essential to take into account the severity of the disease, the location of the disease, and the patient's medical history.
- Sulfasalazine has been found to be more likely to induce remission compared to placebo, but it is less effective than corticosteroids 4.
- Mesalamine derivatives, such as Pentasa, have been shown to be effective in maintaining remission in patients with Crohn's disease 5, 6.
- The use of immunosuppressants, biologics, or small molecules may be considered in patients with more severe disease or those who do not respond to initial treatment, although there is limited evidence to support their use in mild Crohn's disease 7.