Purpose of review: The aim of this article is to review current evidence-based approaches to treatment of ulcerative colitis and Crohn's disease.
Recent findings: The primary goal of treatment is to induce and to maintain remission in a safe and efficacious fashion. The 5-aminosalicylic acid (5-ASA) agents and oral steroids remain the first-line approach for the treatment of ulcerative colitis and Crohn's disease. The ‘step-up’ approach includes the use of immunomodulators [azathioprine (AZA), or 6-mercaptopurine (6-MP)] and newer biologic agents (infliximab, adalimumab, and natalizumab). The ‘step-down’ approach can also be considered individually on the basis of the severity of Crohn's disease.
Summary: Current treatment regimens still involve medications with well known efficacy and safety profiles and progress to more potent treatments such as immunomodulators and biologic agents. Adverse events of potent treatment with biologics and immunomodulators have been recognized. In some cases, aggressive approaches with the use of more potent agents as first-line therapy has been proposed, but they are still not considered a routine approach.
aDivision of Gastroenterology, University of Pennsylvania, Philadelphia, USA
bDepartment of Gastroenterology, Medical University, Wroclaw, Poland
Correspondence to Gary R. Lichtenstein, MD, Professor of Medicine, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Gastroenterology Division, 3400 Spruce Street, 3rd Floor Ravdin Building, PA 19104-4283 Philadelphia, USA Tel: +1 215 662 3544; fax: +1 215 349 5915; e-mail: firstname.lastname@example.org