Induction therapy for severe Crohn disease in adults

Induction therapy to induce remission in patients with severe Crohn disease is an intravenous corticosteroid. Suitable regimens include:

The optimal duration of intravenous corticosteroid therapy is not known; it is generally given for 3 to 7 days depending on the patient’s response. Switch to oral corticosteroids when disease activity has subsided (see Induction therapy for mild to moderate Crohn disease in adults for dosage).

Antibiotics do not have a role in therapy unless transmural complications (eg abscess, complex fistula) are present. Abscesses require radiological drainage and may require surgery. Surgery may also be required for patients with fistulas or bowel obstruction.

Refer patients with severe Crohn disease who cannot tolerate or are refractory to corticosteroid induction therapy to a gastroenterologist for consideration of biological therapy, such as a tumour necrosis factor (TNF) inhibitor (eg adalimumab, infliximab), interleukin inhibitor (eg ustekinumab), or anti-integrin antibody (eg vedolizumab).

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.