Week 6- Crohn's disease therapeutics

Question 1

what affects the choice of therapy? 4 things

Answer 1

• Disease location
• Disease activity and severity
• Previous response to therapy
• Presence of complications

Question 2

what is the treatment for inducing remission in crohns disease if the patient has had a single inflammatory exacerbation in 12 month period?

Answer 2

-monotherapy is glucccorticosteriod at first presentation or a single inflammatory exacerbation in 12 month period
use prednisolone, methylprednisolone, hydrocortisone (IV)
-budesonide may also be considered

Question 3

what is the treatment for inducing remission in crohns disease if the patient has had 2 or more inflammatory exacerbation in 12 month period or if glucocorticosteriod dose cant be tampered?

Answer 3

-add on therapy Consider adding azathioprine or mercaptopurine to glucocorticosteroid or
budesonide to induce remission
-Consider adding methotrexate to glucocorticosteroid or budesonide in those who
cannot tolerate azathioprine or mercaptopurine or low TPMT activity

Question 4

what 2 drugs are used as alternatives for serve disease and if the disease is not responding to conventional therapy?

Answer 4

• Infliximab and Adalimumab

-should be given as a planned course, be reviewed

Question 5

what is the treatment for maintaining remission in crohns disease ?

Answer 5

-Offer azathioprine or
mercaptopurine when previously
used in induction strategy; or consider
in those not previously receiving this
-Consider methotrexate only in those
who needed it at induction, tried and
did not tolerate/CI azathioprine or
mercaptopurine
-steroids shouldn't be used for maintenance
-patient should be made aware of symptoms of a relapse (unintentional weight
loss, abdo pain, diarrhoea, ill-health)
-smoking cessation