From the Guidelines
Treatment for acute Crohn's disease should prioritize biologic therapies, including anti-TNF agents, for moderate to severe cases that have failed to achieve clinical remission with corticosteroids, as recommended by the most recent and highest quality evidence 1.
Overview of Treatment Options
The treatment of acute Crohn's disease involves a multi-faceted approach to reduce inflammation, manage symptoms, and improve quality of life. The primary goal is to induce and maintain clinical remission.
Medication Options
- Corticosteroids like prednisone (40-60mg daily, tapered over 8-12 weeks) are often used as initial treatment to quickly control inflammation.
- Aminosalicylates such as mesalamine (2-4g daily) may be helpful for mild flares.
- Immunomodulators like azathioprine (2-3mg/kg/day) or methotrexate (25mg weekly) are used for longer-term management of moderate to severe cases.
- Biologic therapies, including anti-TNF agents (infliximab 5mg/kg at weeks 0,2, and 6, then every 8 weeks; adalimumab 160mg initially, 80mg at week 2, then 40mg every other week), are effective for moderate to severe disease that has not responded to conventional therapy 1.
Additional Management Strategies
- Patients should maintain hydration and consider a low-residue diet to reduce bowel irritation.
- Rest is recommended as needed.
- Pain management with acetaminophen is preferred over NSAIDs, which can worsen symptoms.
- Antibiotics like ciprofloxacin or metronidazole may be prescribed if infection is suspected.
Enteral Nutrition
- Enteral nutrition (EN) is effective in treating the acute phase of Crohn's disease, particularly in children and adolescents, and can be used as primary therapy or in combination with drugs 1.
- EN has a favorable impact on inflammatory processes, induces remission, treats undernutrition, and avoids the side effects of conventional immune-modulating and suppressing agents.
Prioritizing Treatment
The most recent and highest quality evidence supports the use of biologic therapies, including anti-TNF agents, as the primary treatment option for moderate to severe acute Crohn's disease that has failed to achieve clinical remission with corticosteroids 1. This approach prioritizes the reduction of morbidity, mortality, and improvement of quality of life for patients with acute Crohn's disease.
From the FDA Drug Label
HUMIRA is a tumor necrosis factor (TNF) blocker indicated for: 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.
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 Pediatric Patients 6 Years of Age and Older: Pediatric Weight Recommended Dosage Days 1 and 15Starting on Day 29 17 kg (37 lbs) to less than 40 kg (88 lbs) Day 1: 80 mg Day 15: 40 mg 20 mg every other week 40 kg (88 lbs) and greaterDay 1: 160 mg (single dose or split over two consecutive days) Day 15: 80 mg 40 mg every other week
The treatment option for acute Crohn's disease is adalimumab (HUMIRA). The recommended dosage is:
- For adults: 160 mg on Day 1,80 mg on Day 15, and 40 mg every other week starting on Day 29.
- For pediatric patients 6 years of age and older:
- For patients weighing 17 kg to less than 40 kg: 80 mg on Day 1,40 mg on Day 15, and 20 mg every other week.
- For patients weighing 40 kg and greater: 160 mg on Day 1,80 mg on Day 15, and 40 mg every other week. 2
From the Research
Treatment Options for Acute Crohn's Disease
- The treatment options for acute Crohn's disease include:
- These treatments can be used to induce and maintain remission in Crohn's disease, with the choice of treatment depending on the severity and location of the disease, as well as the patient's response to previous treatments 3, 5, 6, 7
Induction of Remission
- Exclusive enteral nutrition is recommended as the first line of treatment for the induction of remission in pediatric Crohn's disease 5
- Corticosteroids are also effective for inducing remission, but may be associated with significant adverse events 5, 7
- Infliximab is effective for inducing remission in patients who continue to have significant active disease despite the use of conventional treatments 5, 6