Document Detail


Medical management of Crohn's disease.
MedLine Citation:
PMID:  21988215     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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-aminosalicylic acid, 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.
Authors:
Mario Cottone; Sara Renna; Ambrogio Orlando; Filippo Mocciaro
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Expert opinion on pharmacotherapy     Volume:  12     ISSN:  1744-7666     ISO Abbreviation:  Expert Opin Pharmacother     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-10-12     Completed Date:  2012-02-07     Revised Date:  2013-11-06    
Medline Journal Info:
Nlm Unique ID:  100897346     Medline TA:  Expert Opin Pharmacother     Country:  England    
Other Details:
Languages:  eng     Pagination:  2505-25     Citation Subset:  IM    
Affiliation:
University of Palermo, Villa Sofia-V. Cervello Hospital, Division of Internal Medicine, DI.BI.MIS, Via Trabucco 180, 90146, Palermo, Italy.
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / therapeutic use
Aminosalicylic Acids / therapeutic use
Anti-Bacterial Agents / therapeutic use*
Anti-Inflammatory Agents / therapeutic use*
Biological Agents / therapeutic use
Bone Marrow Transplantation
Budesonide / therapeutic use
Crohn Disease / drug therapy*,  surgery
Humans
Immunosuppressive Agents / therapeutic use*
Intestines / surgery
Methotrexate / therapeutic use
Purines / therapeutic use
Remission Induction
Treatment Outcome
Tumor Necrosis Factor-alpha / antagonists & inhibitors
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Aminosalicylic Acids; 0/Anti-Bacterial Agents; 0/Anti-Inflammatory Agents; 0/Biological Agents; 0/Immunosuppressive Agents; 0/Purines; 0/Tumor Necrosis Factor-alpha; 51333-22-3/Budesonide; 59-05-2/Methotrexate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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