Fast Five Quiz: Management of Crohn Disease

Jaime Shalkow, MD

Disclosures

January 12, 2022

For patients with moderately to severely active Crohn disease and endoscopic evidence of active disease, anti-integrin therapy with or without an immunomodulator should be considered for the purpose of inducing symptomatic remission.

Anti-integrin agents halt the trafficking of lymphocytes from the circulation into the intestinal wall, thereby stopping the inflammatory response targeted at the bowel.

For older patients (age > 60 years), anti–tumor necrosis factor monotherapy, anti–interleukin-12/-23 monotherapy, or anti-integrin monotherapy is preferred as induction therapy due to the potentially higher risk for infection and cancer with combination therapy.

Corticosteroids may be helpful in addressing symptoms but they are not effective when it comes to resolving mucosal disease, even for mild to moderate and moderate to severe disease.

Immunomodulators have a slow onset of action (2-3 months) and therefore are not effective for short-term induction; however, they are beneficial in maintaining remission.

Antimycobacterial therapy is ineffective for induction or maintenance of remission nor for mucosal healing.

Learn more about treatment of Crohn disease.

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