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Positioning Therapy for Crohn’s Disease

  • Inflammatory Bowel Disease (S Hanauer, Section Editor)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

The therapy of Crohn’s disease is constantly evolving. It is widely recognized that clinical assessment does not stage disease activity accurately and that endoscopic healing is associated with improved long-term outcomes. Disease management is therefore transitioning to a new paradigm that includes direct assessment of disease severity (endoscopically in most patients), followed by assessment of mucosal healing. New approaches have helped optimize the use of the thiopurines, methotrexate and anti-TNF agents. Novel agents with different mechanisms of action are expanding our therapeutic armamentarium. The major challenge of the future will be to identify patient subgroups best suited to particular therapeutic approaches. In the meantime, studies of comparative effectiveness will be crucial in positioning therapies relative to each other.

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Abbreviations

6-MMPR:

6-methyl-mercaptopurine ribonucleotides

6-TGN:

6-thioguanine nucleotides

ADA:

Adalimumab

AZA:

Azathioprine

AZTEC:

Azathioprine for Treatment of Early Crohn’s disease in adults

CD:

Crohn’s disease

CDAI:

Crohn’s disease activity index

CI:

Confidence interval

COMMIT:

Combination of Maintenance Methotrexate-Infliximab Trial

CZP:

Certolizumab pegol

EBV:

Epstein-Barr Virus

HR:

Hazard ratio

IFX:

Infliximab

IL:

Interleukin

IMM:

Immunomodulators

MP:

Mercaptopurine

MTX:

Methotrexate

OR:

Odds ratio

RAPID:

Résultat de l’Adjonction Précoce d’ImmunoDépresseurs

RBC:

Red blood cells

RR:

Relative Risk

SIR:

Standardized incidence ratio

TNFα:

Tumor necrosis factorα

TPMT:

Thiopurine methyltransferase

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Conflict of Interest

Dr. Dassopoulos has nothing to disclose.

Dr. Gutierrez reports grants and personal fees from ABBVIE, grants and personal fees from JANSSEN, and personal fees from UCB outside the submitted work.

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This article does not contain any studies with human or animal subjects performed by the author.

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Authors and Affiliations

  1. Section of Gastroenterology and Hepatology, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA

    Alexandra Gutierrez & Themistocles Dassopoulos

  2. Gastroenterology Division, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8124, St. Louis, MO, 63110, USA

    Alexandra Gutierrez & Themistocles Dassopoulos

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  1. Alexandra Gutierrez
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Correspondence to Themistocles Dassopoulos.

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This article is part of the Topical Collection on Inflammatory Bowel Disease

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Gutierrez, A., Dassopoulos, T. Positioning Therapy for Crohn’s Disease. Curr Gastroenterol Rep 16, 384 (2014). https://doi.org/10.1007/s11894-014-0384-2

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