Medical treatment of Crohn's disease

Crohn's disease is a chronic heterogenic condition whose management depends on factors such as the site of the disease, its severity and associated complications. Whilst early studies demonstrated the efficacy of corticosteroids and sulphasalazine in active Crohn's disease, only recently have trials demonstrated benefits from maintenance treatment with agents such as mesalazine, corticosteroids, and immune modifiers. Improved dose targeting with specific formulations of mesalazine and budesonide have also improved the therapeutic ratio of these compounds. Metronidazole is a commonly employed agent for perianal Crohn's disease, alternative antibiotics including ciprofloxacin and clarithromycin have also been investigated. 6-mercaptopurine (6-MP) and azathioprine have demonstrated benefits in patients with active steroid-dependent Crohn's disease, although there is a delayed onset of response of 3-6 months with 6-MP; maintenance benefits persist for at least three years whilst on treatment. Methotrexate has also been demonstrated to have steroid-sparing properties in active Crohn's disease, and long-term studies are required to evaluate its potential. Future immune modifiers may include cytokines, anti-cytokines and lymphocyte-specific therapies. In conclusion, the options for the medical therapy of both active Crohn's disease and the maintenance of remission have greatly increased in recent years. Research into the pathophysiology of Crohn's disease and the novel immune modulators carry the promise of more effective and better tolerated therapies in the future.