Medical Therapy of Crohn’s Disease

Mild

• Oral 5-ASA: for colonic Crohn’s disease

• Symptom control: loperamide/cholestyramine for diarrhea management.

Mild-mod

• PO budesonide: enteric-coated for ileal release (taper over 3 mos)

Moderate- severe

• PO prednisone: same as UC, for inducing remission, not maintenance

• AZA/6-MP: same as UC; ↑ remission w/ AZA+IFX (NEJM 2010;362:1383)

• MTX: 15–25 mg IM/SC or PO qwk for maintenance; 1–2 mo to take effect

Severe or refractory disease

(NEJM 2016; 375:1946)

• IV steroids: same as UC, for inducing remission, not maintenance

• Anti-TNF: infliximab, adalimumab or certolizumab (pegylated); consider combination therapy with AZA/6-MP

• Alternative agents: vedolizumab (α4β7 integrin inhibitor); ustekinumab (IL-12/23 inhibitor); natalizumab (α4 integrin inhibitor)

• Investigational: tofacitinib (JAK inhibitor); ozanimod (S-1-P receptor agonist)