Review article: treatment algorithms to maximize remission and minimize corticosteroid dependence in patients with inflammatory bowel disease.
BACKGROUND
Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory diseases of the intestine, which frequently require surgery for complications or failure of medical therapy.


OBJECTIVE
To seek evidence and provide direction for clinicians on optimal strategies to enable steroid free remission in inflammatory bowel disease.


METHODS
Scientific literature was reviewed using MEDLINIE with a specific focus on medical therapies for inducing and maintaining remission of CD and UC. The results were discussed at a roundtable meeting to reach a consensus on key issues.


RESULTS
Several therapies have demonstrated efficacy for the treatment of active, moderate-to-severe CD and UC. These include agents, which induce remission [corticosteroids, infliximab and adalimumab (CD only)] or maintain remission and spare corticosteroids [azathioprine, mercaptopurine, methotrexate (CD only), infliximab and adalimumab (CD only)]. Wide variability exists in the use of these agents.


CONCLUSIONS
Treatment strategy algorithms are developed for use of these therapies that maximize remission and minimize corticosteroid dependence in patients with moderate-to-severe CD and UC.
Department of Medicine, University of Calgary, Calgary, AB, Canada. rpanacci@ucalgary.ca
R
R
Panaccione
P
P
Rutgeerts
W J
WJ
Sandborn
B
B
Feagan
S
S
Schreiber
S
S
Ghosh
D000068879:Adalimumab; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000465:Algorithms; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D002648:Child; D002985:Clinical Protocols; D016572:Cyclosporine / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000473:pathology; D000069285:Infliximab; D007413:Intestinal Mucosa / Q000187:drug effects / Q000473:pathology; D015122:Mercaptopurine / Q000031:analogs & derivatives / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction / Q000379:methods; D012720:Severity of Illness Index
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000069285:Infliximab; D015122:Mercaptopurine; D000068879:Adalimumab; D008727:Methotrexate