Maneuvering Clinical Pathways for Crohn ’s Disease

AbstractPurpose of ReviewCrohn ’s disease management has changed significantly with increasing use of biologics. We review the recent literature on the clinical management of Crohn’s disease and new approaches in selecting and optimizing therapy.Recent FindingsRecent studies have addressed the efficacy of proactive anti-TNF α trough level monitoring, the efficacy of biosimilars, and the efficacy and immunogenicity of newer biologics including anti-integrin therapy and anti-IL12/23 therapy. Optimizing anti-TNFα therapy according to trough concentrations correlates with improved remission rates. Patients can be switche d from the reference drug to a biosimilar, or vice versa, without a measurable change in efficacy, safety, or immunogenicity. Immunomodulators are effective in decreasing immunogenicity and boosting anti-TNFα drug level. The anti-integrin and anti-IL12/23 therapies are effective as induction and ma intenance therapy with low immunogenicity and excellent safety profiles. Patients at high risk for post-operative recurrence should be started on a biologic therapy within 4 weeks post-op.SummaryMultiple biologic therapies are currently available for treatment of Crohn ’s disease including anti-TNFα therapy, anti-integrin therapy, and anti-IL12/23 therapy. The choice of first-line therapy should be based on individual risk-benefit analysis, route of administration, and patient preference. Patient with inadequate response should have their trough level checke...
Source: Current Gastroenterology Reports - Category: Gastroenterology Source Type: research