Severe and Steroid-Resistant Crohn’s Disease

Vol. 76, No. 2, 2007

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Paper

Severe and Steroid-Resistant Crohn's Disease
Pierre Michetti^a, Christian Mottet^a, Pascal Juillerat^a, Valérie Pittet^c, Christian Felley^a, John-Paul Vader^c, Jean-Jacques Gonvers^a, Florian Froehlich^{a, b}

^aDivision of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne,
^bGastrointestinal Department, University of Basle, Basle, and
^cHealthcare Evaluation Unit, Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland

Address of Corresponding Author

Digestion 2007;76:99-108 (DOI: 10.1159/000111023)

Key Words

Crohn's disease, therapy
Crohn's disease, review
Steroids
Azathioprine
Methotrexate
Infliximab
Adalimumab
Certolizumab

Abstract

Patients with moderate-to-severe disease and patients with steroid-refractory or steroid-dependent disease differ in their management, as the latter two groups usually involve patients whose condition is less acute. Systemic corticosteroids represent the mainstay of the management of moderate-to-severe disease and remain the first-line therapy in this setting. Anti-TNF agents represent choice alternatives for patients who do not respond to steroids or in whom steroids are contraindicated. Purine analogues, methotrexate and infliximab have all shown efficacy in achieving steroid-free remission in patients with steroid-refractory or steroid-dependent disease. Other fast-acting immunosuppressors showed little benefit. Surgery may be indicated in this setting. Natalizumab may prove useful in patients refractory to infliximab and other anti-TNF agents.

Author Contacts

Pierre Michetti, MD
Division of Gastroenterology and Hepatology
Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46
CH-1011 Lausanne (Switzerland)
Tel. +41 21 314 06 90, Fax +41 21 314 07 07, E-Mail pierre.michetti@chuv.ch

Article Information

Published online: February 7, 2008
Number of Print Pages : 10
Number of Figures : 0, Number of Tables : 0, Number of References : 89

Medline Abstract (ID 18239400)

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