title: Severe and steroid-resistant Crohn's disease.
abstract: Patients with moderate to severe disease and patients with steroid-refractory or steroid-dependent disease differ in their management, as the latter groups usually include patients with less acute situations. Systemic corticosteroids represent the mainstay of the management of moderate to severe disease and remain the first-line therapy in this setting. Infliximab is the choice alternative for patients who do not respond to steroids or in whom steroids are contraindicated. Purine analogues, methotrexate and infliximab have shown efficacy in achieving steroid-free remission in patients with steroid-refractory or -dependent disease. Other fast-acting immunosuppressors showed little benefit. Surgery may be indicated in this setting. Nataluzimab may prove useful in patients refractory to infliximab.
authors.affiliation: Division of Gastroenterology and Hepatology, Lausanne University Medical Center, Lausanne, Switzerland. pierre.michetti@chuv.hospvd.ch
authors.forename: Pierre
authors.initials: P
authors.lastname: Michetti
authors.forename: Christian
authors.initials: C
authors.lastname: Mottet
authors.forename: Pascal
authors.initials: P
authors.lastname: Juillerat
authors.forename: Christian
authors.initials: C
authors.lastname: Felley
authors.forename: John-Paul
authors.initials: JP
authors.lastname: Vader
authors.forename: Bernard
authors.initials: B
authors.lastname: Burnand
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Gonvers
authors.forename: Florian
authors.initials: F
authors.lastname: Froehlich
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy*; D004351:Drug Resistance; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D012720:Severity of Illness Index
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D005938:Glucocorticoids; D000069285:Infliximab