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Review article: treatment algorithms to maximize remission and minimize corticosteroid dependence in patients with inflammatory bowel disease Panaccione R; Rutgeerts P; Sandborn WJ; Feagan B; Schreiber S; Ghosh SAliment Pharmacol Ther 2008[Sep]; 28 (6): 674-88BACKGROUND: Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory diseases of the intestine, which frequently require surgery for complications or failure of medical therapy. AIM: To seek evidence and provide direction for clinicians on optimal strategies to enable steroid free remission in inflammatory bowel disease. METHODS: Scientific literature was reviewed using MEDLINIE with a specific focus on medical therapies for inducing and maintaining remission of CD and UC. The results were discussed at a roundtable meeting to reach a consensus on key issues. RESULTS: Several therapies have demonstrated efficacy for the treatment of active, moderate-to-severe CD and UC. These include agents, which induce remission [corticosteroids, infliximab and adalimumab (CD only)] or maintain remission and spare corticosteroids [azathioprine, mercaptopurine, methotrexate (CD only), infliximab and adalimumab (CD only)]. Wide variability exists in the use of these agents. CONCLUSION: Treatment strategy algorithms are developed for use of these therapies that maximize remission and minimize corticosteroid dependence in patients with moderate-to-severe CD and UC.|Adalimumab[MESH]|Adolescent[MESH]|Adrenal Cortex Hormones/therapeutic use[MESH]|Adult[MESH]|Algorithms[MESH]|Anti-Inflammatory Agents/*therapeutic use[MESH]|Antibodies, Monoclonal, Humanized[MESH]|Antibodies, Monoclonal/therapeutic use[MESH]|Child[MESH]|Clinical Protocols[MESH]|Cyclosporine/therapeutic use[MESH]|Dose-Response Relationship, Drug[MESH]|Drug Therapy, Combination[MESH]|Humans[MESH]|Immunosuppressive Agents/*therapeutic use[MESH]|Inflammatory Bowel Diseases/*drug therapy/pathology[MESH]|Infliximab[MESH]|Intestinal Mucosa/drug effects/pathology[MESH]|Mercaptopurine/analogs & derivatives/therapeutic use[MESH]|Methotrexate/therapeutic use[MESH]|Randomized Controlled Trials as Topic[MESH]|Remission Induction/methods[MESH]|Severity of Illness Index[MESH] |
