Conventional therapy for Crohn’s disease

Table 1 Drugs for the treatment of CD

Drug	5-ASA (mesalamine or sulfasalazine)
Dosage	3.2-4 g/d
Indications	Mild to moderately active disease, postoperative maintenance
Important side effects	Headache, nausea and abdominal pain, often during treatment with sulfasalazine (in up to 45% of patients); thrombopenia; interstitial nephitis, pancreatitis;
Monitoring	Liver function, full blood count and especially renal function
Pregnancy	Suggested to be safe in conventional doses

Table 2 Drugs for the treatment of CD

Drug	Systemicorticosteroids (prednisone equivalent) or budesonide
Dosage	Corticosteroids: 30-60 mg/d or 1-1.5 mg/kg per day; Budesonide: 9 mg
Indications	Corticosteroids: moderate to severe disease. Budesonide: terminal ileal and right colonic disease in mild to moderate disease, low dose budesonide eventually for maintenace therapy
Important side effects	Weight gain, hypertension, fluid retention, myopathy, mood changes, infections, glaucoma, skin changes including acne, adrenal suppresion. Long term side effects: osteoporosis, cataract, aseptic bone necrosis
Pregnancy	Lower doses seem to be relatively safe
Comments	Avoid long-term use

Table 3 Drugs for the treatment of CD

Drug	Azathioprine (6-mercaptopurine)
Dosage	2-2.5 mg/kg (1-1.5 mg/kg)
Indications	Maintenance, chronically active disease, steroid- refractory and steroid-dependency, fistulae, concommittant therapy with infliximab;
Important side effects	Pancreatitis, bone marrow supression, allergic reactions, drug heptatitis, nausea, malaise, bacterial and viral infections; in patients intolerant to azathioprine due to gastrointestinal symptoms, 6-mercaptopurine is suggested (not in side effects such as pancreatitis and bone marrow suppression)
Monitoring	Liver function, lipase and full blood count biweekly for the first three months, if normal then every three months throughout therapy
Pregnancy	Should be avoided, although available studies suggest a potential use especially in patients where maintaining remission is essential
Comments	Entire therapeutic efficacy is observed mostly after 2-4 mo; consider testing for thiopurine methyltransferase (TPMT) genotypes to identify patients with high-risk of bone marrow suppression; consider metabolite monitoring for adaequate dosing; ensure adequate birth control; allow 3 mo time before pregnancy or conceiving

Table 4 Drugs for the treatment of CD

Drug	Methotrexate
Dosage	25 mg/wk i.m., if remission is achieved reduce to 15 i.m. (or s.c.)
Indications	Maintenance, chronically active disease, steroid-refractory and steroid-dependency, fistulae
Important side effects	Nausea, abdominal pain, diarrhea, stomatitis; hepatitis, liver fibrosis; hypersensivity pneumonitis
Monitoring	Liver function and full blood count monthly for the first two months, if normal then every two months throughout therapy
Pregnancy	Strictly prohibited
Comments	Entire therapeutic efficacy is observed mostly after 2-4 mo; consider folic acid supplementation with 2.5-5 mg/d; ensure adequate birth control; allow 3 mo time before pregnancy or conceiving

Table 5 Drugs for the treatment of CD

Drug	Metronidazole
Dosage	10-20 mg/kg
Indications	Mild to moderately active disease; fistulae (usually prolonged treatment)
Important side effects	Nausea, metallic taste in the mouth, coating of the tongue, peripheral neuropathy
Monitoring	See side effects
Pregnancy	Long term treatment not yet evaluated, short term treatment appears to be safe

Table 6 Drugs for the treatment of CD

Drug	Ciprofloxacin
Dosage	1-2 g/d
Indications	Mild to moderately active disease, fistulae
Important side effects	Taste disturbance, gastrointestinal events, tendopathies
Monitoring	Generelly well tolerated, see side effects
Pregnancy	Probably safe

Table 7 Drugs for the treatment of CD

Drug	Infliximab
Dosage	5 mg/kg per infusion; usually started at wk 0, 2, and 6 and then repeated every 8 wk if necessary
Indications	Chronically active disease, steroid-refractory and steroid-dependency, maintenance, fistulae
Important side effects	Nausea, headache, abdominal pain, infections, sepsis; infusions reactions (early or delayed), reactivation of tuberculosis
Monitoring	Vital signs around infusion
Pregnancy	Unknown
Comments	Exclude tuberculosis before infusions, consider concommittant use of imunosuppressants (azathioprine) to reduce antibody formation