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 two groups usually involve patients whose condition is less acute. Systemic corticosteroids represent the mainstay of the management of moderate-to-severe disease and remain the first-line therapy in this setting. Anti-TNF agents represent choice alternatives for patients who do not respond to steroids or in whom steroids are contraindicated. Purine analogues, methotrexate and infliximab have all shown efficacy in achieving steroid-free remission in patients with steroid-refractory or steroid-dependent disease. Other fast-acting immunosuppressors showed little benefit. Surgery may be indicated in this setting. Natalizumab may prove useful in patients refractory to infliximab and other anti-TNF agents.
Michetti
Pierre
P
Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland. pierre.michetti@chuv.ch
Mottet
Christian
C
Juillerat
Pascal
P
Pittet
Valérie
V
Felley
Christian
C
Vader
John-Paul
JP
Gonvers
Jean-Jacques
JJ
Froehlich
Florian
F
D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D003424:Crohn Disease / Q000188:drug therapy* / Q000473:pathology*; 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