Current medical treatment possibilities

The aim of current treatment for Crohn's disease (CD) is to induce and maintain a complete remission, with the mainstay of treatment for active CD being the use of corticosteroids, mesalazine and the immune modulators azathioprine and methotrexate. The efficacy of prednisone and budesonide has been well established and these induce remission in up to 80% of patients. However, some patients are steroid refractory, others remain steroid-dependent and many suffer from severe side-effects. Mesalazine therapy has yielded conflicting results, some studies reporting efficacy, and others being negative. Both azathioprine and methotrexate have been shown to be effective in maintaining remission in steroid-dependent patients. Unfortunately, some patients do not respond to these standard therapies, and thus, possible additional immune-modulating therapies have been initiated. Monoclonal antibodies directed against the T-cell proteins CD4 and intergrin alpha 4 beta 7, have shown encouraging results. Clinical data also exist for antibodies against tumour necrosis factor-a and interleukin (IL)-10. In humans, a phase II clinical study has shown encouraging results in CD using IL-10 therapy. Although these clinical studies are still in the early stage the prolonged use of antibody therapy has been shown to be much safer than previously considered. Further studies are required to establish whether these possible new therapies are efficacious and safe alternatives for the treatment of CD.