Maintaining remissions accross the lifespan: A roundtable with Crohn's disease experts

Moderator (Dr. Lichtenstein): In summary, where does mesalamine fit in our current treatment regimen of Crohn's disease in 2003? Dr. Present: Mesalamine is first-line therapy for mild-to-moderate disease - for induction of remission and, in patients who respond, for maintenance. I think this is quite clear. That's what most of us do in practice. For the average patient with mild-to-moderate disease, mesalamine is still the mainstay. Dr. Hanauer: I would say I totally agree with that statement. In addition, I think that there is evidence - it's not as strong, but evidence - of mesalamine's effect in delaying post-operative occurrence at the ileum after an ileal resection. The evidence becomes weaker as more of the colon is involved, probably with people with more penetrating complications. Dr. Kane: I think that community physicians are tempted to give the quick fix, so they start corticosteroids. They need to explain to the patient that they didn't get sick overnight, and we're not going to make them well overnight. They need to educate patients that if they stick with mesalamine, a very safe drug, then 2 to 6 weeks from now, they'll feel better. Dr. Lichtenstein: This has been discussed for a decade. I believe in the "don't burn bridges" concept. Don't use the more potent drugs when you don't need to because when you need them, they may not be there. The other concept is that "the punishment has to meet the crime." Don't punish patients with overtreatment if they've got mild disease. Dr. Cuffari: I agree. Treat with your least toxic medication initially, and then maintain remission, which is important to help improve quality of life, and potentially alter the course of the disease. Dr. Hanauer: Crohn's is not an 8-week disease. We have to think long-term and plan what we're going to do. And advise patients to stop smoking. Dr. Present: I think of induction of remission and maintenance. No matter what I'm using for induction, I'm still thinking of maintenance. If I can get them to be maintained on mesalamine, that's the best scenario. It's the safest drug. Dr. Kane: Advise patients to be patient and educate them on the reason for any particular medication you've prescribed. Dr. Present: And don't use corticosteroids.