Crohn's disease
Chronic transmural immune-mediated inflammation of any GI segment from mouth to anus, most often terminal ileum. Symptoms: diarrhea, abdominal pain, weight loss, fever, fistulas, strictures. ECCO 2024 and the Spanish GETECCU 2023 tier therapy by location, severity, complications: mild – budesonide or short-course systemic steroids; moderate/severe – immunomodulators (azathioprine, methotrexate) and biologics (anti-TNFα: infliximab, adalimumab, certolizumab; ustekinumab; vedolizumab; risankizumab). Mesalazine is not effective in Crohn's disease (unlike UC).
Also known as: Regional enteritis, Granulomatous enteritis
Drugs used for this condition
- AAdalimumabSecond line · Biologic – tumor necrosis factor alpha (TNFα) inhibitorBiologic (TNF-alpha inhibitor) for moderate-to-severe Crohn's disease in patients with inadequate response or intolerance to corticosteroids and immunomodulators (azathioprine, 6-mercaptopurine) per ECCO 2020. Induction 160 mg subcutaneously, 80 mg at week 2, then 40 mg every 2 weeks. Reduces hospitalizations and surgery and maintains remission (registrational CLASSIC-I and CHARM trials). Mandatory pre-treatment screening for latent tuberculosis and hepatitis B.
- AUstekinumabSecond line · Biologic – interleukin-12 and -23 inhibitorSecond-line for moderate-to-severe Crohn's disease per ECCO 2024 after anti-TNFα (infliximab, adalimumab) failure or intolerance. IV induction by body weight (260–520 mg), then 90 mg subcutaneously every 8 weeks. UNITI showed 30% reduction in relapse risk over 44 weeks.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit