From the Guidelines
Management of a Crohn's disease (CD) flare-up involves a step-up approach, starting with induction of remission using medications such as systemic steroids, followed by maintenance therapy with immunosuppressants like azathioprine or biologics like anti-TNF agents.
Treatment Options
- Systemic steroids: used to induce remission in acute flare-ups, with a typical dose of prednisolone 40-60 mg/day 1
- Immunosuppressants: such as azathioprine, 6-mercaptopurine, or methotrexate, used for maintenance therapy to prevent recurrent disease flares 1
- Biologics: including anti-TNF agents like infliximab, adalimumab, or golimumab, used in cases of insufficient response to immunosuppressive treatment or intolerance 1
Approach to Management
The approach to management of CD involves a combination of medical, surgical, and endoscopic treatment, with the aim of improving or completely resolving symptoms, improving or restoring quality of life, avoiding hospitalization, and promoting endoscopic mucosal healing whilst minimizing adverse events 1.
Disease Severity
The choice of treatment regimen depends on several factors, including the type, distribution, and disease severity, as well as co-morbidity and patient preferences 1.
Recent Guidelines
Recent guidelines, such as the ECCO guidelines on therapeutics in Crohn's disease, provide evidence-based recommendations for the management of CD, including the use of medical treatment, surgical interventions, and endoscopic treatment 1.
From the Research
Management of Crohn's Disease Flare-up
The management of a Crohn's disease (CD) flare-up involves a comprehensive approach that includes both medical and surgical interventions.
- The goal of treatment is to reduce inflammation, manage symptoms, and prevent complications 2, 3, 4.
- Medical therapy for CD flare-ups typically involves the use of steroids, such as prednisone, to rapidly reduce inflammation and manage symptoms 2, 3, 4.
- Biologic agents, such as tumor necrosis factor (TNF) inhibitors, interleukin (IL) 12/23 inhibitors, and Janus kinase (JAK) inhibitors, may also be used to treat CD flare-ups, especially in patients who do not respond to steroids or have a history of steroid dependence 5, 3, 4.
- Immunomodulators, such as azathioprine and 6-mercaptopurine, may be used to maintain remission and prevent future flare-ups 2, 4.
- Surgical interventions, such as bowel resection or stricturoplasty, may be necessary in some cases to manage complications, such as bowel obstruction, abscesses, or fistulas 2, 3, 4.
Treatment Approach
The treatment approach for CD flare-ups should be individualized based on the patient's disease severity, medical history, and personal preferences 2, 3, 4.
- A stepwise approach to treatment may be used, starting with mild therapies and progressing to more aggressive treatments as needed 3.
- The treatment plan should also take into account the patient's risk of complications, such as osteoporosis, infections, and malignancies, and include measures to prevent these complications 4.
- Patient education and support are also essential components of CD management, as they can help patients understand their disease, manage their symptoms, and adhere to their treatment plan 2, 4.
Emerging Therapies
Several emerging therapies are being investigated for the treatment of CD flare-ups, including novel biologic agents and small molecule inhibitors 5.
- These therapies aim to target specific pathways involved in the pathogenesis of CD, such as the IL-23 pathway, and may offer improved efficacy and safety profiles compared to existing treatments 5.
- Further research is needed to fully evaluate the efficacy and safety of these emerging therapies and to determine their role in the management of CD flare-ups 5.