Cushing K, Higgins PDR, et al.
JAMA. Date of publication 2021 Jan 5;volume 325(1):69-80.
1. JAMA. 2021 Jan 5;325(1):69-80. doi: 10.1001/jama.2020.18936.
Management of Crohn Disease: A Review.
Cushing K(1), Higgins PDR(1).
Author information:
(1)Division of Gastroenterology, Department of Internal Medicine, University of
Michigan, Ann Arbor.
Comment in
JAMA. 2021 May 4;325(17):1793-1794. doi: 10.1001/jama.2021.2918.
IMPORTANCE: Crohn disease, a chronic gastrointestinal inflammatory disease, is
increasing in incidence and prevalence in many parts of the world. Uncontrolled
inflammation leads to long-term complications, including fibrotic strictures,
enteric fistulae, and intestinal neoplasia. Therefore, early and effective
control of inflammation is of critical importance.
OBSERVATIONS: The optimal management approach for Crohn disease incorporates
patient risk stratification, patient preference, and clinical factors in
therapeutic decision-making. First-line therapy generally consists of steroids
for rapid palliation of symptoms during initiation of anti-tumor necrosis factor
α therapy. Other treatments may include monoclonal antibodies to IL-12/23 or
integrin α4β7, immunomodulators, combination therapies, or surgery. Effective
control of inflammation reduces the risk of penetrating complications (such as
intra-abdominal abscesses and fistulae), although more than half of patients
will develop complications that require surgery. Adverse reactions to therapy
include antibody formation and infusion reactions, infections, and cancers
associated with immune modulators and biologics and toxicity to the bone marrow
and the liver. Both Crohn disease and corticosteroid use are associated with
osteoporosis. Vaccinations to prevent infections, such as influenza, pneumonia,
and herpes zoster, are important components of health maintenance for patients
with Crohn disease, although live vaccines are contraindicated for patients
receiving immune suppression therapy.
CONCLUSIONS AND RELEVANCE: The treatment of patients with Crohn disease depends
on disease severity, patient risk stratification, patient preference, and
clinical factors, including age of onset and penetrating complications, and
includes treatment with steroids, monoclonal antibody therapies,
immunomodulators, and surgery. Physicians should be familiar with the advantages
and disadvantages of each therapy to best counsel their patients.
DOI: 10.1001/jama.2020.18936
PMCID: PMC9183209
PMID: 33399844 [Indexed for MEDLINE]
Conflict of interest statement: Conflict of Interest Disclosures: Dr Higgins
reported receiving grant funding from the National Institutes of Health, the
Crohn’s and Colitis Foundation, Pfizer, AbbVie, Eli Lilly, Twine Clinical
Consulting, Target PharmaSolutions, Shire, Seres, Genentech, Janssen, Takeda,
and UCB and consulting for Pfizer, Eli Lilly, Takeda, and Arena Pharmaceuticals.
No other disclosures were reported.
