Severe and steroid-resistant Crohn's disease.
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.
Michetti
Pierre
P
Division of Gastroenterology and Hepatology, Lausanne University Medical Center, Lausanne, Switzerland. pierre.michetti@chuv.hospvd.ch
Mottet
Christian
C
Juillerat
Pascal
P
Felley
Christian
C
Vader
John-Paul
JP
Burnand
Bernard
B
Gonvers
Jean-Jacques
JJ
Froehlich
Florian
F
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
D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D005938:Glucocorticoids; D000069285:Infliximab