Beyond molecular biology: Improving quality of life in patients with Crohn's disease

Crohn's disease (CD) is a lifelong, incurable illness that typically requires decades of medical care. Patients with CD experience high rates of surgery, significantly impaired quality of life, depression, and economic hardship. Immunosuppressive and immunomodulatory agents have long been used for the treatment of CD, but are often of limited efficacy in patients with moderate-to-severe disease, or are associated with significant safety and tolerability problems. Surgery and nutrition therapy are also important components of the management of patients with CD. Inhibition of the inflammatory cytokine tumor necrosis factor (TNF)-α has recently emerged as an important therapeutic option for patients with CD, as demonstrated by the clinically significant improvement in symptoms with the anti-TNF therapy infliximab. A number of newer anti-TNF therapies have been evaluated in recent clinical trials. Some of these agents, including adalimumab and certolizumab pegol, have been shown to improve the symptoms of CD in initial clinical studies and are currently being evaluated in large randomized trials. Although these therapies are expected to be more expensive than conventional therapies for initial treatment, it is possible that newer treatments may reduce overall long-term treatment costs by reducing the need for hospitalization and surgical expenses, which account for more than 80% of CD-related healthcare costs. Economic analyses of clinical trial data for newer CD therapies have demonstrated reduced medical resource use, including the need for hospitalization and surgery, among patients who received anti-TNF therapies. Patient education and effective patient-physician communication are essential to maintain patient adherence to treatment and to identify and manage psychological consequences of CD and CD therapy.