Overview of maintenance therapy for Crohn disease in adults

Crohn disease is a relapsing and remitting condition; most patients need ongoing therapy to maintain remission. Options for drug therapy to maintain remission include thiopurines, methotrexate or biological therapy (eg adalimumab, infliximab, ustekinumab, vedolizumab).

Biological therapies are effective in maintaining remission if there was response to induction therapy with these drugs; refer to a gastroenterologist. Long-term biological therapy may be required to maintain remission in some patients.

Corticosteroids should not be used as maintenance therapy to prevent relapse of Crohn disease because they are no more effective than placebo, do not induce mucosal healing, and are associated with serious long-term adverse effects.

Maintenance therapy for Crohn disease in adults is usually lifelong. De-escalation of therapy should only be considered in patients with stable disease and evidence of mucosal healing on endoscopy—consult the patient’s gastroenterologist before attempting de-escalation.