Maintenance treatment in Inflammatory Bowel Disease (IBD)

Abstract

Ulcerative colitis and Crohn's disease are complex disorders
reflected by wide variation in clinical practice.
Lifelong maintenance treatment is recommended for all
patients with ulcerative colitis, especially those with left -
sided or extensive disease and those with distal disease,
who relapse more than once a year. Oral mesalazine 2g/day
should be considered as first-line therapy. Steroids are not
effective at maintaining remission. Azathioprine 1,5-2,5 mg/
kg/day or mercaptopurine 0,75-1,5 mg/kg/day should be
reserved for patients who frequently relapse, despite adequate
doses of aminosalicylates. Patients who have failed
to respond to immunomodulators benefit from repeated
maintenance therapy with infliximab, ideally on an every 8
week basis.
The efficacy of drug therapy in the maintenance treatment
of Crohn's disease depends on whether remission was
achieved with medical or surgical therapy, on the risk of
relapse and on the site of disease. Mesalazine seems to be
ineffective at doses < 2 g/day. It is clearly ineffective for
those who have needed steroids to induce remission. Azathioprine
should be reserved as second line therapy. Steroid
dependent patients and patients with steroid refractory
disease should be considered for treatment with immunomodulators.
Infliximab is effective at a dose of 5 mg/kg
every 8 weeks in patients who have responded to the initial
infusion. It is best used with immunomodulators. Moreover,
it is the best evidenced-based therapy for the fistulating
disease at the present time.
Ulcerative colitis and Crohn's disease, collectively termed inflammatory bowel disease, are complex disorders reflected
by wide variation in clinical practice.