MEDICAL THERAPY OF ACTIVE CROHNS-DISEASE

Active Crohn's disease constitutes a major problem in gastroenterology . Symptoms vary with site, extent and local complications of the disea se as well as with the absence or presence of extraintestinal manifest ations. Due to the troublesome consequences of the disease new treatme nts have continuously been tried. However, the results have varied and no definite breakthrough has occurred in the medical treatment of act ive Crohn's disease during the last years. The new salicylates have sh own some effect using higher doses, but have not fulfilled the expecta tions once connected with their development. The new steroids have com pared well to, but not exceeded, the older corticosteroid preparations in terms of therapeutic efficacy but they have a better side-effect p rofile. The role of the purine analogs azathioprine/6-mercaptopurine h as been further evaluated. The onset of their effect is slow, an intra venous loading dose might shorten this time span, and they are steroid sparing. The controlled data on methotrexate are limited and the long -term effects not well studied and there is concern about toxicity. Ev en the use of cyclosporine in active Crohn's disease is controversial and connected with serious adverse events. Studies on the new immune m odulating therapies such as anti-TNF-cx antibodies, anti-CD4 antibodie s, interleukin-10 and interferon have been encouraging but large scale studies are still awaited before the effect and the spectra of side-e ffects can be fully evaluated. The aim of this chapter is to summarize the present knowledge of medical treatment of active Crohn's disease and to point towards the directions of new therapeutic options.