The American Gastroenterological Association (AGA) has released new guidelines which suggest that anti-TNF-alpha biologic agents, such as infliximab or adalimumab, can induce remission in patients with moderately severe Crohn's disease.
Additionally, the guidelines recommend against using thiopurines or methotrexate alone to induce remission in these patients. The new guideline1 and accompanying technical review2 have been published in Gastroenterology, the official journal of the AGA Institute. The AGA Clinical Decision Support Tool, based on the guideline, can be reviewed at gastro.org/crohnsdecisiontool.
Crohns Disease
Crohn's disease or regional enteritis is an inflammatory bowel disease that involves the small intestine and causes abdominal pain, diarrhea and bleeding.
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"Crohn's disease is a lifelong, relapsing disorder that can damage the bowel and lead to multiple abdominal operations over time. Deciding which medications are the best is a common dilemma for gastroenterologists and the Crohn's patients we treat. The disease can be disabling, but the drugs to control the disease can be toxic too and they can be costly. Balancing the benefits and the risks of the drugs and determining which medicines are most likely to keep the patient healthy is critical," according to Jonathan P. Terdiman, MD, lead author of the guidelines, and Chief of the Gastroenterology Service at the University of California, San Francisco Medical Center. "The new AGA guideline and clinical decision support tool will ease the decision process by providing transparent and actionable recommendations."
Crohn's disease is a chronic inflammatory bowel disease that causes significant morbidity and represents a considerable burden to society. It is estimated that 300,000 to 500,000 Americans suffer from Crohn's disease, costing the health-care system between $2.5 and $4 billion per year.
![Digestive Tract Ulcers Symptom Evaluation]( "Digestive Tract Ulcers Symptom Evaluation")
A break in the mucus membrane lining of the digestive tract results in ulcers.
These guidelines are the first to make medication recommendations based on methodology that includes review of risks and benefits, patient preferences, and the quality of clinical evidence.
For the induction of remission, the guidelines recommend:
Source: Eurekalert
Digestive Tract Ulcers Symptom Evaluation
A break in the mucus membrane lining of the digestive tract results in ulcers.
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These guidelines are the first to make medication recommendations based on methodology that includes review of risks and benefits, patient preferences, and the quality of clinical evidence.
For the induction of remission, the guidelines recommend:
- Using anti-TNF-α drugs to induce remission in patients with moderately severe Crohn's disease (strong recommendation, moderate-quality evidence).
- Using anti-TNF-α monotherapy over thiopurine monotherapy to induce remission in patients who have moderately severe Crohn's disease (strong recommendation, moderate-quality evidence).
- Using anti-TNF-α drugs in combination with thiopurines over thiopurine monotherapy to induce remission in patients who have moderately severe Crohn's disease (strong recommendation, high-quality evidence).
- Using thiopurines over no immunomodulator therapy to maintain a steroid-induced remission in patients with Crohn's disease (strong recommendation, moderate-quality evidence).
- Using anti-TNF-α drugs over no anti-TNF-α drugs to maintain a steroid or anti-TNF-α drug-induced remission in patients with Crohn's disease (strong recommendation, high-quality evidence).
Source: Eurekalert
Ulcerative Colitis
Ulcerative colitis is characterized by bouts of diarrhea, bleeding per rectum and pain, which remits and relapses. Fulminant colitis is a possibility, which may require colectomy.
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