Medical management of Crohn's disease

被引:14
作者
Cottone, Mario [1 ]
Renna, Sara [1 ]
Orlando, Ambrogio [1 ]
Mocciaro, Filippo [2 ]
机构
[1] Univ Palermo, Villa Sofia V Cervello Hosp, Div Internal Med, DIBIMIS, I-90146 Palermo, Italy
[2] Civico ARNAS Hosp, Gastroenterol Unit, Palermo, Italy
关键词
Crohn's; medical management; therapy; INFLAMMATORY-BOWEL-DISEASE; PLACEBO-CONTROLLED TRIAL; T-CELL LYMPHOMA; INTERCELLULAR-ADHESION MOLECULE-1; ANTIINTERFERON-GAMMA ANTIBODY; ACTIVE THERAPEUTIC MOIETY; NECROSIS-FACTOR-ALPHA; DOUBLE-BLIND; LONG-TERM; MAINTENANCE THERAPY;
D O I
10.1517/14656566.2011.609556
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Introduction: The medical approach to Crohn's disease has been modified in recent years thanks to the introduction of new therapies, like biologics. Also, well-designed studies and systematic reviews have allowed better evaluation of the role of old drugs like steroids and immunosuppressors. This review aims to evaluate the recent evidence on the medical approach to Crohn's disease in the different settings of the disease. Areas covered: Randomized controlled trials and meta-analyses were included in the review. The research on all the studies discussed was based on the Cochrane Library, Medline and Embase, using the following medical subject headings: Crohn's disease, clinical trial, therapy, 5-aminosalicylicacid, steroid, budesonide, immunosuppressant, anti-meta-analysis TNF and biologics. Expert opinion: In a mild active inflammatory ileocecal disease, budesonide is considered the best approach. The efficacy of aminosalicylates is limited, but a trial that has recently compared aminosalicylates and budesonide has shown that the two drugs are comparable. In a mild colonic disease, sulfasalazine, antibiotics and steroids are effective but the evidence for antibiotics is less clear. The maintenance of remission in this setting is debatable, but sulfasalazine seems the better choice. In a moderate severe ileal and colonic disease, steroids are the best therapy to induce remission. Once remission is reached, immunosuppressors remain today the better choice to maintain the remission. Anti-TNF therapy is indicated in patients intolerant or not responding to steroids and immunosuppressors and in fistulizing Crohn's disease. Early therapy with biologics may be considered in patients with severe disease.
引用
收藏
页码:2505 / 2525
页数:21
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