What is the treatment approach for moderate to severe Crohn disease?

Updated: Jul 26, 2019
  • Author: Leyla J Ghazi, MD; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Answer

For the treatment of moderate to severe Crohn disease, current recommendations include the “top-down” approach, which differs from the conventional step-up approach in that more potent agents are administered initially. Top-down therapies include biologic agents and steroids as needed versus combination therapy with both biologic drugs and immunomodulator agents.

Randomized trials have shown that the combination of azathioprine or 6-MP with a biologic agent is more effective in the induction of remission, steroid-free remission, and mucosal healing than either azathioprine/6-MP alone or a biologic agent alone. [87] However, it is unclear whether these findings hold true in clinical practice; thus, physicians must consider the risks and benefits of therapy to avoid overtreatment.

Azathioprine or 6-MP is effective for maintenance of remission in Crohn disease; each is effective for avoiding surgery and for preventing postoperative and endoscopic relapse. [12] Both agents can be used in combination with infliximab.


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