Induction therapy for mild to moderate Crohn disease in adults
Corticosteroids are the most effective drugs for inducing remission in active Crohn disease; response rates in most clinical trials are about 60 to 70% at 12 to 16 weeks. Use:
prednisolone (or prednisone) 40 to 50 mg orally, daily in the morning until clinical response, then taper over 6 to 8 weeks to stop. prednisolone prednisolone prednisolone
For ileocaecal disease, consider using an enteric-coated preparation of budesonide (eg Entocort, Budenofalk), particularly for patients with a history of adverse reactions to systemic corticosteroids or precautions to their use (eg diabetes). Use:
budesonide enteric-coated 9 mg orally, daily in the morning for 4 to 8 weeks, then taper over 2 to 4 weeks in 3 mg increments to stop1. budesonide budesonide budesonide
For patients who require repeated or prolonged courses of corticosteroids, consider escalating therapy—see Induction therapy for severe Crohn disease in adults.
Antibiotics do not have a role in therapy unless there is confirmed infection.
In adults with Crohn disease, exclusive enteral nutrition (using a polymeric formula) has been shown to be well tolerated and as effective as corticosteroids for inducing remission. However, adherence to exclusive enteral nutrition can be challenging—consider patient preferenceHansen, 2018.