Therapeutic Optimization in Crohn's Disease - Episode 20

Prescribing Aggressive Therapies & Specific Treatments

Stephen B. Hanauer: Because approximately 80% of patients will develop progressive Crohn disease, we have tried to identify the factors that are associated with disease progression or the opposite: the lack of progression. We know that individuals who develop Crohn disease at young ages, who have extensive gut involvement, present with complications such as perianal fistula, cigarette smokers, and most importantly, individuals with deep ulcers, are more likely to progress. Those are the individuals that we should look to administer more appropriate or early-aggressive therapy, to halt that progression.

In the setting of Crohn disease, both the AGA [American Gastroenterological Association] as well as the American College of Gastroenterology [ACG] have identified the factors that I mentioned as predictors of poor disease outcomes. In those individuals, we have several options that have yet to be compared in efficacy studies; those options include a short course of corticosteroids with transition to immunomodulators such as thiopurines or methotrexate [Trexall], the introduction of TNF [tumor necrosis factor] inhibitors with or without immunomodulators, anti-integrins with or without immunomodulators, and most recently, ustekinumab [Stelara], with or without immunomodulators.

Transcript edited for clarity.