title: Immunomodulators for the treatment of Crohn's disease in adults: optimal use and prospects for future drug treatments.
abstract: Crohn's disease (CD) requires treatment beyond symptoms by enabling and maintaining mucosal healing and therefore clinical remission. However, with the increasing use of biologics there have been safety concerns and there is a significant cost implication with the early use of biologics. Therefore, it is imperative that patients with severe/complicated disease or poor prognostic factors are treated with an aggressive strategy while all remaining patients should be treated in a step-up strategy. The potential for disease modification with thiopurines and methotrexate is debated in CD when they are used as a monotherapy. In this review we discuss existing and newer therapies that have recently been developed for CD. We will also provide an algorithm for current management of adult CD patients in routine clinical practice.
authors.affiliation: a Gastroenterology , Ulster Hospital , Belfast , N. Ireland, UK.
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Allen
authors.affiliation: b Department of Gastroenterology , University Hospital of Nancy-Brabois , Vandoeuvre-lès-Nancy , France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000328:Adult; D000465:Algorithms; D000818:Animals; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy*; D003955:Diagnostic Tests, Routine; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D000069285:Infliximab / Q000627:therapeutic use*; D008727:Methotrexate / Q000627:therapeutic use*
chemical_list: D007155:Immunologic Factors; D000069285:Infliximab; D000068879:Adalimumab; D008727:Methotrexate
keywords: Adalimumab; Crohn’s disease; Infliximab; Methotrexate; Mongersen; Tacrolimus; Thiopurines; Tofacitinib; anti-TNF