Mini-Reviews and PerspectivesCurrent Directions in IBD Therapy: What Goals Are Feasible With Biological Modifiers?
Section snippets
Disease Course
Crohn's disease and ulcerative colitis are chronic, immune-mediated inflammatory diseases of the GI tract.1, 2
Crohn's Disease
The historic treatment goals for Crohn's disease were to eliminate symptoms with as few side effects and long-term sequelae as possible (Table 1).11 Therapy for mild to moderate disease comprised mesalamine, antibiotics, and topical corticosteroids; therapy for moderate to severe disease consisted of systemic corticosteroids and immunosuppressives (azathioprine, 6-mercaptopurine, methotrexate), thereby reserving biologics (infliximab,12, 13, 14, 15 adalimumab,16, 17, 18, 19 certolizumab,20, 21,
Crohn's Disease
The current evolution of treatment goals for Crohn's disease include steroid sparing, endoscopic healing, and reducing hospitalization and surgery (Table 1). Mesalamine is not steroid sparing. Steroid sparing for azathioprine has been demonstrated only as prophylactic therapy.27 Methotrexate, infliximab, adalimumab, and natalizumab are all effective for maintenance of steroid-free remission.13, 19, 24, 36 Steroid-sparing data are lacking for certolizumab. Future treatment strategies may
Crohn's Disease
Potential future treatment goals for Crohn's disease include reduction in bowel damage and prevention of complications (stricture, fistula, abscess) and maintaining normal GI physiology (Table 1). Achievement of these treatment goals requires early therapy with effective maintenance agents. Mesalamine is not effective. Steroids are effective for induction but not maintenance.26 Combination therapy with steroids (induction) and 6-mercaptopurine (maintenance) have demonstrated superior rates of
Conclusions
Crohn's disease is a chronic progressive destructive disease and current treatment strategies are inadequate. An evolution to early treatment with either azathioprine and/or anti-TNF is likely, with the goals of reduction in bowel damage, prevention of complications, and maintaining normal GI physiology. Ulcerative colitis is a disease with a variable course, which in a subgroup of patients results in colectomy with ileoanal pouch or stoma. An evolution to treatment goals to sustained clinical
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The author discloses the following: Dr Sandborn is supported by Procter & Gamble Pharmaceuticals, Shire Pharmaceuticals, Centocor, Abbott Laboratories, UCB Pharma. Dr Sandborn is a consultant for Procter & Gamble Pharmaceuticals, Shire Pharmaceuticals, Salix Pharmaceuticals, Centocor, Abbott Laboratories, UCB Pharma, and Elan.