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Maneuvering Clinical Pathways for Crohn’s Disease

  • Inflammatory Bowel Disease (S Hananauer, Section Editor)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Crohn’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 Findings

Recent studies have addressed the efficacy of proactive anti-TNFα 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 switched 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 maintenance 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.

Summary

Multiple 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 checked and therapy optimized. Therapeutic prophylaxis for post-operative recurrence should be based on patient’s risk factors for recurrence.

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  1. Section of Gastroenterology, Hepatology and Nutrition, Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, 60637, USA

    Thomas X. Lu & Russell D. Cohen

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Correspondence to Russell D. Cohen.

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Russell Cohen reports personal fees from Abbvie, Celgene, Janssen, Pfizer, and Takeda, outside the submitted work. Thomas Lu declares no conflict of interest.

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Lu, T.X., Cohen, R.D. Maneuvering Clinical Pathways for Crohn’s Disease. Curr Gastroenterol Rep 21, 20 (2019). https://doi.org/10.1007/s11894-019-0687-4

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