The importance of early intervention and the benefit of consistent treatment in Crohn's disease therapy

The dysregulated inflammatory response associated with Crohn's disease leads to an imbalance between pro-inflammatory and anti-inflammatory mediators, tissue damage, and clinical symptoms including bleeding, diarrhea, abdominal pain, and weight loss. The development of biologic therapy, in particular the blockade of the TNF-α pathway, has been a fundamental advance in the treatment of patients with Crohn's disease. Although only 2 biologic agents are currently approved by the US Food and Drug Administration for the treatment of Crohn's disease, 2 others are currently under review for approval. Current use and data from maintenance trials strongly suggest that once an anti-TNF biologic is initiated in patients with moderate-to-severe Crohn's disease, it should be continued over the long-term in order to optimize long-term clinical efficacy and to prevent immunogenicity. Early treatment with biologic therapy might also have a clinical benefit in terms of disease progression. Clinicians should not be overly aggressive in their approach and unnecessarily treat all patients up-front with biologics or immunomodulators. However, minimization of patient suffering is a reasonable and important goal of therapy, particularly in patients experiencing a severe disease course.