title: Update on the Medical Management of Crohn's Disease.
abstract: The medical management of Crohn's disease is a rapidly evolving field with expanding therapeutic drug options and treatment strategies. In addition to corticosteroids, immunomodulators, and anti-tumor necrosis (anti-TNF) agents, a new anti-adhesion medication (vedolizumab) has been approved. Individualized patient-based dosing of immunomodulators and biologic agents is now possible with therapeutic drug monitoring (TDM). There is a changing paradigm in treatment goals to achieve deeper remission identified by composite clinical and endoscopic endpoints. More aggressive treatment strategies in the postoperative setting have been proposed due to emerging data on medication efficacy in this setting. Management algorithms that stratify CD patients into risk groups to balance treatment benefit against adverse events and costs are being developed to translate research into clinical practice. This review provides an update on these new developments for practicing gastroenterologists.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA. deepak.parakkal@mayo.edu.
authors.forename: Parakkal
authors.initials: P
authors.lastname: Deepak
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA. bruining.david@mayo.edu.
authors.forename: David H
authors.initials: DH
authors.lastname: Bruining
mesh_terms: D010131:Aminosalicylic Acid / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D003424:Crohn Disease / Q000188:drug therapy*; D019468:Disease Management; D016903:Drug Monitoring / Q000379:methods; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008727:Methotrexate / Q000627:therapeutic use; D011687:Purines / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007155:Immunologic Factors; D011687:Purines; D014409:Tumor Necrosis Factor-alpha; D010131:Aminosalicylic Acid; C543529:vedolizumab; D008727:Methotrexate
keywords: Antibodies; Crohn’s disease management; Drug monitoring; Humanized/therapeutic use; Monoclonal; Tumor necrosis factor-alpha/antagonists and inhibitors