Factors Guiding Treatment Choice in Crohn’s Disease

Opinion
Video

Dr Sara Horst leads the discussion on the commonly followed treatment approach in the community for moderate to severe Crohn's Disease (CD) and highlights the factors that should guide treatment choices.

This is a video synopsis/summary of a panel discussion involving Marla Dubinsky, MD; David Rubin, MD; Miguel Regueiro, MD; Remo Panaccione, MD, FRCPC; and Sara Horst, MD, MPH.

The discussion revolves around the prevalent treatment approaches for moderate to severely active Crohn's disease in the community. The primary focus is on the common use of corticosteroids and mesalamine, and the challenges associated with these choices.

Corticosteroids are identified as frequently prescribed in the community, particularly for newly diagnosed patients who experience a rapid improvement in symptoms. However, the downside is that patients may not adhere to follow-up appointments, leading to repeated steroid use. mesalamine is also noted as one of the top choices, driven by clinicians' comfort levels and perceptions of safety, despite limited evidence supporting its efficacy in Crohn's disease, especially small bowel involvement.

The conversation emphasizes the need to move beyond these initial treatments and consider advanced therapies for moderate to severe cases. The hesitancy to adopt advanced therapies is attributed to factors such as clinician comfort, historical practices, and the predictability of corticosteroid response. However, the limitations of steroids and mesalamine as maintenance drugs are highlighted, prompting the need for a strategic plan for long-term management.

The historical significance of steroids in managing inflammatory bowel disease (IBD) is acknowledged, but the conversation urges a shift towards recognizing the need for more targeted and sustainable treatment options. The term "easy" is used to describe the convenience of prescribing steroids and mesalamine, especially in brief patient visits common in community practices. However, the discussion emphasizes the importance of recognizing when a patient requires advanced therapy, considering factors like repeated steroid use, disease severity, and the need for a more disease-modifying approach.

The dialogue suggests a paradigm shift in approaching Crohn's disease treatment, acknowledging steroids as a gateway to advanced therapy. The idea is to use steroids as a temporary solution while promptly planning for more effective and long-term management strategies. The challenges of short patient visits in community practices are acknowledged, but the importance of initiating discussions about advanced therapy early in the treatment process is underscored. Overall, the conversation encourages a proactive and strategic approach to managing moderate to severely active Crohn's disease.

Video synopsis is AI-generated and reviewed by HCPLive editorial staff.

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