The state of the art on treatment of Crohn's disease

J Gastroenterol. 2018 Sep;53(9):989-998. doi: 10.1007/s00535-018-1479-6. Epub 2018 Jul 6.

Abstract

Crohn's disease (CD) is a chronic, progressive, and destructive disease of the gastrointestinal tract. Although its incidence appears to be stable or decreasing in most countries in the North America and Europe, the incidence is rising rapidly in Asian countries. Immunomodulators and biologics are increasingly used to avoid long-term bowel damage and subsequent disability. Therapeutic drug monitoring facilitates optimizing thiopurines and anti-TNFs use. New biologic agents targeting various pathological pathways of CD are blooming in recent years, and the high cost of biologics and expiration of patents for several biologic agents have driven the utility of biosimilars for CD treatment. Here, the literature regarding the efficacy, safety, and withdrawal of the drugs, as well as the evolution of therapeutic targets will be reviewed.

Keywords: Biologics; Crohn’s disease; Mucosal healing; Target.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / adverse effects
  • Adrenal Cortex Hormones / therapeutic use
  • Asia / epidemiology
  • Azathioprine / adverse effects
  • Azathioprine / therapeutic use
  • Crohn Disease / drug therapy*
  • Crohn Disease / epidemiology*
  • Drug Monitoring
  • Humans
  • Immunomodulation*
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use
  • Incidence
  • Infliximab / adverse effects
  • Infliximab / therapeutic use
  • Methotrexate / adverse effects
  • Methotrexate / therapeutic use
  • Purines / adverse effects
  • Purines / therapeutic use*
  • Remission Induction
  • Thalidomide / adverse effects
  • Thalidomide / therapeutic use
  • Thionucleosides / adverse effects
  • Thionucleosides / therapeutic use*
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*

Substances

  • Adrenal Cortex Hormones
  • Immunosuppressive Agents
  • Purines
  • Thionucleosides
  • Tumor Necrosis Factor-alpha
  • Thalidomide
  • Infliximab
  • Azathioprine
  • Methotrexate