Current treatment modalities in active Crohn's disease

The aetiology of Crohn's disease is unknown and, therefore, no curative tre atments are currently available. Crohn's disease treatment requires knowled ge of several variables affecting patient's responsiveness including: chara cteristics of the disease and of the host, as well as the specific purposes of treatment and the characteristics of the effective drugs. Currently ava ilable drugs for active Crohn's disease include: a) old drugs (oral/topical salicylates, conventional steroids); b) old drugs with a newface (immunosu ppressives, antibacterial drugs); c) new drugs (budesonide, anti-cytokines/ cytokines, probiotics). Among the old drugs corticosteroids (1 mg/kg) are t he most effective, with a 65-85% induction of remission, when compared to h igh dose sulphasalazine (3-5 g/day) (12%) and 5-aminosalicylic acid (4 g/da y) (25%). The following drugs represent current treatment modalities in ste roid/refractory active Crohn's disease. Immunosuppressives, including azath ioprine (2-2.5 mg/kg) and 6-mercaptopurine (1-1.5 mg/kg) are less effective than steroids (30-40% vs 65-85%), but in chronic active Crohn's disease th ey show a 76% "steroid-sparing" effect and 63% fistula closure. The reporte d efficacy of methotrexate (25 mg/kg) and cyclosporine A in fistulous Crohn 's disease needs to be confirmed Antibiotics, such as metronidazole and cip rofloxacin (1 g/day) are effective in perianal or colonic active Crohn's di sease. (Budesonide, a steroid with low systemic absorption, shows an effica cy comparable to prednisone in active small bowel Crohn's disease. Bowel re st and enteral feeding are effective in active Crohn's disease. To summariz e, conventional steroids still represent the most effective drugs in active Crohn's disease. However refractory disease, steroid-dependence, drug-side effects and/or complications may require two main alternative management s trategies: a) surgical resection in localized or primary Crohn's disease; b ) alternative drugs in extensive or recurrent Crohn's disease.