title: Inflammatory bowel disease therapy: current state-of-the-art.
abstract: OBJECTIVE
  The aim of this article is to review current evidence-based approaches to treatment of ulcerative colitis and Crohn's disease.
  
  
  RESULTS
  The primary goal of treatment is to induce and to maintain remission in a safe and efficacious fashion. The 5-aminosalicylic acid (5-ASA) agents and oral steroids remain the first-line approach for the treatment of ulcerative colitis and Crohn's disease. The 'step-up' approach includes the use of immunomodulators [azathioprine (AZA), or 6-mercaptopurine (6-MP)] and newer biologic agents (infliximab, adalimumab, and natalizumab). The 'step-down' approach can also be considered individually on the basis of the severity of Crohn's disease.
  
  
  CONCLUSIONS
  Current treatment regimens still involve medications with well known efficacy and safety profiles and progress to more potent treatments such as immunomodulators and biologic agents. Adverse events of potent treatment with biologics and immunomodulators have been recognized. In some cases, aggressive approaches with the use of more potent agents as first-line therapy has been proposed, but they are still not considered a routine approach.
authors.affiliation: Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA 19104-4283, USA.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Blonski
authors.forename: Anna M
authors.initials: AM
authors.lastname: Buchner
authors.forename: Gary R
authors.initials: GR
authors.lastname: Lichtenstein
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000636:Aminosalicylic Acids / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D019819:Budesonide / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D000069285:Infliximab; D015122:Mercaptopurine / Q000627:therapeutic use; D000069442:Natalizumab
chemical_list: D000305:Adrenal Cortex Hormones; D000636:Aminosalicylic Acids; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D000069442:Natalizumab; D019819:Budesonide; D000069285:Infliximab; D015122:Mercaptopurine; D001379:Azathioprine