Medical management of mild to moderate Crohn's disease: evidence-based treatment algorithms for induction and maintenance of remission.
BACKGROUND
Patients with Crohn's disease alternate between periods of active, symptomatic disease and periods of remission. The treatment goal for Crohn's disease is to induce and then maintain remission of symptoms.


OBJECTIVE
To review evidence from randomized, controlled, clinical trials on medical therapies for inducing and maintaining remission in patients with mild-to-moderate Crohn's disease, and to suggest the best evidence-based approaches for induction and maintenance therapies.


METHODS
PubMed search using the following terms: sulfasalazine or salicylazosulfapyridine or aminosalicylate or aminosalicylic acid or mesalamine or mesalazine or corticosteroid or prednisone or prednisolone or methylprednisolone or budesonide or antibiotic or metronidazole or ciprofloxacin or immunosuppressive or azathioprine or mercaptopurine or thiopurine or methotrexate and Crohn's disease.


RESULTS
Randomized, controlled trials demonstrated that sulfasalazine, budesonide, and conventional corticosteroids are effective for inducing remission of mild-to-moderate Crohn's disease when administered for a period of 8-16 weeks. An ideal maintenance therapy does not currently exist.


CONCLUSIONS
Selection of maintenance therapy is based on a combination of evidence from controlled trials and patient features including disease severity and location, co-morbidities, previous response to treatment, and previous surgical resection. The options for maintenance therapy include therapy cessation and patient observation following successful induction, budesonide, or immunosuppressive therapy.
Sandborn
W J
WJ
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA. sandborn.william@mayo.edu
Feagan
B G
BG
Lichtenstein
G R
GR
D000465:Algorithms; D019819:Budesonide / Q000494:pharmacology / Q000627:therapeutic use*; D003424:Crohn Disease / Q000188:drug therapy*; D005765:Gastrointestinal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D016896:Treatment Outcome
D005765:Gastrointestinal Agents; D005938:Glucocorticoids; D019819:Budesonide