Crohn's disease therapy : step up or top down therapy

In most Crohn's disease scenarios a step-up approach has been used to initi ate therapy according to disease severity. However, this approach has ignor ed the concept of inductive therapy followed by maintenance treatment to pr event relapse. It is apparent from clinical trials that the success of main tenance approaches will depend upon the inductive therapy. Furthermore, the step-up approach often results in steroid-dependent or refractory disease. The potential of aggressive initial therapy followed by step-down maintena nce therapy affords the potential to modify the disease course, a possibili ty that has not been accomplished by current therapeutic algorithims.