Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Luminal Crohn's Disease.
Anti-Bacterial Agents
/ therapeutic use
Anti-Inflammatory Agents, Non-Steroidal
/ therapeutic use
Antibodies, Monoclonal, Humanized
/ therapeutic use
Azathioprine
/ therapeutic use
Budesonide
/ therapeutic use
Canada
Crohn Disease
/ drug therapy
Gastroenterology
Gastrointestinal Agents
/ therapeutic use
Glucocorticoids
/ therapeutic use
Humans
Immunosuppressive Agents
/ therapeutic use
Induction Chemotherapy
Maintenance Chemotherapy
Mesalamine
Methotrexate
/ therapeutic use
Prednisolone
/ therapeutic use
Societies, Medical
Sulfasalazine
/ therapeutic use
Treatment Outcome
Tumor Necrosis Factor Inhibitors
/ therapeutic use
Ustekinumab
/ therapeutic use
5-ASA
Guidance
Mucosal Healing
TNF
Journal
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
ISSN: 1542-7714
Titre abrégé: Clin Gastroenterol Hepatol
Pays: United States
ID NLM: 101160775
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
received:
11
10
2018
revised:
21
02
2019
accepted:
25
02
2019
pubmed:
12
3
2019
medline:
28
10
2020
entrez:
12
3
2019
Statut:
ppublish
Résumé
Crohn's disease (CD) is a lifelong illness with substantial morbidity, although new therapies and treatment paradigms have been developed. We provide guidance for treatment of ambulatory patients with mild to severe active luminal CD. We performed a systematic review to identify published studies of the management of CD. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Statements were developed through an iterative online platform and then finalized and voted on by a group of specialists. The consensus includes 41 statements focused on 6 main drug classes: antibiotics, 5-aminosalicylate, corticosteroids, immunosuppressants, biologic therapies, and other therapies. The group suggested against the use of antibiotics or 5-aminosalicylate as induction or maintenance therapies. Corticosteroid therapies (including budesonide) can be used as induction, but not maintenance therapies. Among immunosuppressants, thiopurines should not be used for induction, but can be used for maintenance therapy for selected low-risk patients. Parenteral methotrexate was proposed for induction and maintenance therapy in patients with corticosteroid-dependent CD. Biologic agents, including tumor necrosis factor antagonists, vedolizumab, and ustekinumab, were recommended for patients failed by conventional induction therapies and as maintenance therapy. The consensus group was unable to clearly define the role of concomitant immunosuppressant therapies in initiation of treatment with a biologic agent. Optimal management of CD requires careful patient assessment, acknowledgement of patient preferences, evidence-based use of existing therapies, and thorough assessment to define treatment success.
Sections du résumé
BACKGROUND & AIMS
Crohn's disease (CD) is a lifelong illness with substantial morbidity, although new therapies and treatment paradigms have been developed. We provide guidance for treatment of ambulatory patients with mild to severe active luminal CD.
METHODS
We performed a systematic review to identify published studies of the management of CD. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Statements were developed through an iterative online platform and then finalized and voted on by a group of specialists.
RESULTS
The consensus includes 41 statements focused on 6 main drug classes: antibiotics, 5-aminosalicylate, corticosteroids, immunosuppressants, biologic therapies, and other therapies. The group suggested against the use of antibiotics or 5-aminosalicylate as induction or maintenance therapies. Corticosteroid therapies (including budesonide) can be used as induction, but not maintenance therapies. Among immunosuppressants, thiopurines should not be used for induction, but can be used for maintenance therapy for selected low-risk patients. Parenteral methotrexate was proposed for induction and maintenance therapy in patients with corticosteroid-dependent CD. Biologic agents, including tumor necrosis factor antagonists, vedolizumab, and ustekinumab, were recommended for patients failed by conventional induction therapies and as maintenance therapy. The consensus group was unable to clearly define the role of concomitant immunosuppressant therapies in initiation of treatment with a biologic agent.
CONCLUSIONS
Optimal management of CD requires careful patient assessment, acknowledgement of patient preferences, evidence-based use of existing therapies, and thorough assessment to define treatment success.
Identifiants
pubmed: 30853616
pii: S1542-3565(19)30253-8
doi: 10.1016/j.cgh.2019.02.043
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Anti-Inflammatory Agents, Non-Steroidal
0
Antibodies, Monoclonal, Humanized
0
Gastrointestinal Agents
0
Glucocorticoids
0
Immunosuppressive Agents
0
Tumor Necrosis Factor Inhibitors
0
Sulfasalazine
3XC8GUZ6CB
Mesalamine
4Q81I59GXC
Budesonide
51333-22-3
Prednisolone
9PHQ9Y1OLM
vedolizumab
9RV78Q2002
Ustekinumab
FU77B4U5Z0
Azathioprine
MRK240IY2L
Methotrexate
YL5FZ2Y5U1
Types de publication
Journal Article
Practice Guideline
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1680-1713Informations de copyright
Copyright © 2019 AGA Institute and the Canadian Association of Gastroenterology. Published by Elsevier Inc. All rights reserved.