title: How to manage difficult Crohn's disease: optimum delivery of anti-TNFs.
abstract: Crohn's disease is a chronic inflammatory condition that can involve any portion of the GI tract, leading to disabling symptoms and complications. Standard treatment with 5-aminosalicylic acid, antibiotics, corticosteroids and immunosuppressives has limited efficacy and is associated with serious potential adverse events. The anti-TNF-alpha agents are effective in the induction and maintenance of remission in luminal and fistulizing Crohn's disease. Recent evidence suggests that early treatment with anti-TNF agents and immunosuppressives may alter the natural history of the disease and prevent late complications. In those patients who have lost response to, or are intolerant of, a single anti-TNF agent, increasing the dose of the medication or switching to alternate biologic agents, such as another anti-TNF drug or natalizumab, have been shown to be effective treatments.
authors: University of British Columbia, Department of Medicine, Division of Gastroenterology, Vancouver, BC, Canada.
authors: Darin S
authors: DS
authors: Krygier
authors: Hin Hin
authors: HH
authors: Ko
authors: Brian
authors: B
authors: Bressler
mesh_terms: D000068879:Adalimumab; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000068582:Certolizumab Pegol; D003424:Crohn Disease / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab; D007413:Intestinal Mucosa / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D011092:Polyethylene Glycols / Q000627:therapeutic use; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014945:Wound Healing / Q000187:drug effects
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005765:Gastrointestinal Agents; D007140:Immunoglobulin Fab Fragments; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D011092:Polyethylene Glycols; D000069285:Infliximab; D000068879:Adalimumab; D000068582:Certolizumab Pegol