What is the treatment for a Crohn's disease (Crohn's disease) exacerbation in a hospital setting?

From the Guidelines

The most effective treatment for a Crohn's disease flare-up in the hospital is intravenous corticosteroids, such as methylprednisolone 40-60 mg/day, to induce symptomatic remission, as recommended by the Canadian Association of Gastroenterology 1.

Treatment Approach

The treatment approach for Crohn's disease flare-up in the hospital involves a combination of medications and supportive care. The primary goal is to control inflammation, manage symptoms, and transition to oral medications before discharge.

• Initial management includes intravenous corticosteroids, such as methylprednisolone (40-60mg daily), to rapidly reduce inflammation, as suggested by the Canadian Association of Gastroenterology 1.
• Patients also receive intravenous fluids for rehydration, electrolyte replacement, and sometimes total parenteral nutrition if they cannot tolerate oral intake.
• Anti-TNF biologics like infliximab may be administered for severe flares not responding to steroids within 3-5 days, as recommended by the Canadian Association of Gastroenterology 1.

Medication Management

Medication management is crucial in treating Crohn's disease flare-ups.

• Corticosteroids, such as prednisone 40-60 mg/day, are recommended for moderate to severe Crohn's disease to induce complete remission, as suggested by the Canadian Association of Gastroenterology 1.
• Immunomodulators, such as thiopurines, may be used to maintain remission in patients who have achieved symptomatic remission on oral corticosteroids, as recommended by the Canadian Association of Gastroenterology 1.
• Anti-TNF biologics, such as infliximab or adalimumab, are recommended as first-line therapy for moderate to severe luminal Crohn's disease with risk factors of poor prognosis, as suggested by the Canadian Association of Gastroenterology 1.

Supportive Care

Supportive care is essential in managing Crohn's disease flare-ups.

• Patients receive intravenous fluids for rehydration and electrolyte replacement.
• Total parenteral nutrition may be necessary if patients cannot tolerate oral intake.
• Pain management with acetaminophen or opioids is provided, though NSAIDs are avoided as they can worsen symptoms.
• Antibiotics, such as ciprofloxacin and metronidazole, are used if infection is suspected or for perianal disease.

Monitoring and Follow-up

Regular monitoring and follow-up are crucial in managing Crohn's disease flare-ups.

• Patients are monitored with regular blood tests, stool studies, and sometimes imaging or endoscopy to assess disease severity and response to treatment.
• The goal is to control inflammation, manage symptoms, and transition to oral medications before discharge, typically after 5-10 days depending on symptom improvement, as suggested by the British Society of Gastroenterology 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 The treatment for Crohn's disease flare up in hospital is Intravenous Infliximab (RENFLEXIS) with a dose of 5 mg/kg given as an induction regimen at 0,2, and 6 weeks, followed by a maintenance regimen of 5 mg/kg every 8 weeks 2.

• Key points:
  • Indicated for moderately to severely active Crohn's disease
  • Given as an intravenous induction regimen
  • Maintenance regimen every 8 weeks
  • Dose of 5 mg/kg
  • For adult patients who have had an inadequate response to conventional therapy

From the Research

Treatment for Crohn's Disease Flare-up in Hospital

• The treatment for Crohn's disease flare-up in hospital typically involves induction therapy with medications such as infliximab, which 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 3.
• Intravenous steroid therapy is also indicated in severe acute flares for both Crohn's disease and ulcerative colitis, which should lead to improvement within the first 72 hours 4.
• If no improvement occurs, medical therapy must be intensified with various therapeutics, including biologics targeting tumor necrosis factor (TNF)-α, α4ß7 integrins, interleukin (IL)-12/23 or IL-23, as well as Janus kinase (JAK) inhibitors, sphingosine 1‑phosphate receptor (S1PR) modulators, and calcineurin inhibitors 4.
• The optimal management approach for Crohn's disease incorporates patient risk stratification, patient preference, and clinical factors in therapeutic decision-making, and may include treatment with steroids, monoclonal antibody therapies, immunomodulators, and surgery 5.

Medications Used

• Infliximab is a commonly used medication for the treatment of Crohn's disease, and is recommended at an initial dose of 5 mg/kg, with some patients requiring maintenance dosing at a higher dose of up to 10 mg/kg 3.
• Other medications that may be used to treat Crohn's disease include adalimumab, certolizumab, vedolizumab, azathioprine, and methotrexate, which have been shown to be effective in inducing and maintaining remission in patients with Crohn's disease 6.
• The choice of medication will depend on the individual patient's needs and medical history, as well as the severity of their disease 5, 4.

Hospitalization and Surgery

• Hospitalization may be necessary for patients with severe Crohn's disease, particularly if they have complications such as infections, strictures, abscesses, or toxic megacolon 4.
• Surgery may also be necessary in some cases, particularly if the patient has penetrating complications or if medical therapy is not effective 5, 4.