THERAPIES FOR CROHN'S DISEASE: a clinical update

SOBRADO, Carlos Walter; LEAL, Raquel Franco; SOBRADO, Lucas Faraco

doi:10.1590/S0004-28032016000300016

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Arquivos de Gastroenterologia

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Sumário

REVIEW • Arq. Gastroenterol. 53 (3) • Jul-Sep 2016 • https://doi.org/10.1590/S0004-28032016000300016 copy

THERAPIES FOR CROHN'S DISEASE: a clinical update

Terapia farmacológica em portadores de doença de Crohn. Atualização clínica

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The main objectives of clinical therapy in Crohn's disease are clinical and endoscopic remission without the use of corticosteroids for long periods of time, prevention of hospitalization and surgery, and improvement of quality of life. The main limitation of drug therapy is the loss of response over the long term, which makes incorporation of new drugs to the therapeutic arsenal necessary. This review analyses the main drugs currently used in clinical treatment of Crohn's disease.

HEADINGS
Crohn disease, therapy; Immunosuppressive agents; Biologic therapy; Quality of life

Drug	Recommended dose	Observations / Guidance
Sulfasalazine	2 to 6 g/dayOral route	Mild CDColorectal involvement
Mesalazine	2 to 4 g/day1.6 to 3.2 g/dayOral route	Mild CDColorectal involvement
Corticosteroids(prednisone)	0.75 to 1 mg/kg/day, up to 60 mg/day (maximum)Oral route	Active CD, only induction of remission
Budesonide	9 mg/dayOral route	Mild to moderate CDTerminal ileum / ileocecal involvement
Azathioprine	2 to 3 mg/kg/dayOral route	Maintenance of remissionSlow onset of action
6-Mercaptopurin	1 to 1.5 mg/kg/dayOral route	Maintenance of remissionSlow onset of action
Methotrexate	25 mg/WeekIntramuscular route	Maintenance of remissionIndicated for patients with intolerance to AZA and 6-MP
Infliximab	5 mg/kg in weeks 0, 2 and 6 (attack) and maintenance every 8 weeks.Intravenous route	Increase to 10 mg/kg or reduce the time between each infusion to every 4-6 weeks, if there is loss of response
Adalimumab	160 mg and 80 mg with a 2-week interval (attack) and maintenance with40 mg every 2 weeks.Subcutaneous route	Reduce the time between each infusion to weekly if there is loss of response
Vedolizumab	300 mg IV in weeks 0, 2 and 6 (attack) and300 mg IV every 8 weeks (maintenance).Intravenous route	Onset of action may be slow

Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia e Outras Especialidades - IBEPEGE. Rua Dr. Seng, 320, 01331-020 São Paulo - SP Brasil, Tel./Fax: +55 11 3147-6227 - São Paulo - SP - Brazil
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[1] Carlos Walter Sobrado. Instituto de Gastrocirurgia, Oncologia e Proctologia. Rua Itapeva, 500, 7º andar. Bela Vista - CEP: 01332-000 - São Paulo, SP, Brasil