Crohn's disease: current treatment options.
There is no known cure for Crohn's disease (CD), but a better understanding of the evidence base of both established treatments (such as enteral nutrition, corticosteroids, 5-aminosalicylates and immunosuppressive agents) and emerging treatments (such as the anti-tumour necrosis factor-alpha (anti-TNF-alpha) agents, infliximab and adalimumab) provides opportunities to improve and maintain the quality of life for children with the disease. This article provides an overview of the evidence base of current medical treatments that are used to induce and maintain remission in CD. Exclusive enteral nutrition is recommended as the first line of treatment for the induction of remission in paediatric CD. Corticosteroids are also effective for inducing remission but may be associated with significant adverse events. Patients with chronically active CD may benefit from immunosuppressive agents such as azathioprine and methotrexate. Infliximab is effective for inducing remission in patients who continue to have significant active disease despite the use of conventional treatments. Adalimumab may be indicated for patients who develop a severe allergic reaction to infliximab or those who initially respond to infliximab but subsequently lose their response. Treatments that have been shown to be effective for the maintenance of remission include azathioprine, methotrexate, infliximab and adalimumab. Recent evidence also suggests that long-term enteral nutritional supplementation with patients taking about half of their daily calorie requirements as enteral nutrition may be an effective strategy for the maintenance of remission in CD. The available evidence does not support the use of corticosteroids or 5-aminosalicylates as maintenance therapy for CD.
Akobeng
A K
AK
Department of Paediatric Gastroenterology, Central Manchester and Manchester Children's University Hospitals, Booth Hall Children's Hospital, Charlestown Road, Blackley, Manchester M9 7AA, UK. tony.akobeng@cmmc.nhs.uk
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D044623:Nutrition Therapy / Q000379:methods*; D011788:Quality of Life / Q000523:psychology; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction / Q000379:methods; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha