How to manage difficult Crohn's disease: optimum delivery of anti-TNFs.

Crohn's disease is a chronic inflammatory condition that can involve any portion of the GI tract, leading to disabling symptoms and complications. Standard treatment with 5-aminosalicylic acid, antibiotics, corticosteroids and immunosuppressives has limited efficacy and is associated with serious potential adverse events. The anti-TNF-alpha agents are effective in the induction and maintenance of remission in luminal and fistulizing Crohn's disease. Recent evidence suggests that early treatment with anti-TNF agents and immunosuppressives may alter the natural history of the disease and prevent late complications. In those patients who have lost response to, or are intolerant of, a single anti-TNF agent, increasing the dose of the medication or switching to alternate biologic agents, such as another anti-TNF drug or natalizumab, have been shown to be effective treatments.