Review article: the evidence base for interventions used to maintain remission in Crohn's disease.
BACKGROUND
Crohn's disease is characterised by recurrent flare-ups alternating with periods of remission. A number of interventions are currently used in clinical practice to try and maintain remission in Crohn's disease but the evidence base for some of them may be questionable.


OBJECTIVE
To review the available evidence on interventions, which are currently used to maintain remission in Crohn's disease.


METHODS
The Cochrane Library and Medline (Pubmed) were searched for level 1 evidence on specific interventions. Search terms included 'Crohn's disease or synonyms', 'remission or synonyms' and the names of specific interventions.


RESULTS
Azathioprine, infliximab and adalimumab are effective at maintaining remission in Crohn's disease. Natalizumab is also effective, but there are concerns about its potential association with progressive multifocal leukoencephalopathy. Long-term enteral nutritional supplementation, enteric-coated omega-3 fatty acids and intramuscular methotrexate may also be effective but the evidence for these is based on relatively small studies. The available evidence does not support the use of oral 5-aminosalicylates agents, corticosteroids, anti-mycobacterial agents, probiotics or ciclosporin as maintenance therapy in Crohn's disease.


CONCLUSIONS
A better understanding of the evidence base of existing interventions could result in the use of treatments, which are more likely to lead to improved patient outcomes.
Akobeng
A K
AK
Department of Paediatric Gastroenterology, Booth Hall Children's Hospital, Central Manchester and Manchester Children's University Hospitals, Manchester, UK. tony.akobeng@cmmc.nhs.uk
D000068879:Adalimumab; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D001379:Azathioprine / Q000627:therapeutic use; D003424:Crohn Disease / Q000188:drug therapy*; D004750:Enteral Nutrition; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D006801:Humans; D000069285:Infliximab; D019804:Mesalamine / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use; D000069442:Natalizumab; D019936:Probiotics / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D015525:Fatty Acids, Omega-3; D000069442:Natalizumab; D019804:Mesalamine; D000069285:Infliximab; D000068879:Adalimumab; D001379:Azathioprine; D008727:Methotrexate