Evolving Treatment Algorithms in Crohn's Disease
2016
Crohn’s disease (CD) is a chronic, disabling and destructive
condition. Half of patients will develop some bowel damage (stricture,
fistula and/or abscess). Current therapeutic strategies failed to alter its
natural history. Treatment of CD has evolved over a quarter of a century
from a linear sequence of treatment intensification to a complex algorithm
focused on individualized patient care by looking beyond symptoms. A tight
monitoring of objective signs of inflammation and a treat to target approach
are probably the only way to change patients’ life and disease course. We
now seek to optimize our therapeutic tools according to patient profile,
disease phenotype and the unique pharmacodynamics that ensues. This article
explores the evolving concepts in assessing disease severity, selecting
rigorous treatment end-targets, initiating an effective therapeutic therapy,
and managing secondary loss of response.
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