Current treatment for prevention of relapse and recurrence in Crohn's disease.

Abstract

Maintenance of remission induced by medical therapy and prevention of recurrence after intestinal resection are two of the major goals in Crohn's disease treatment. Two main groups of drugs are employed in prevention of relapse and recurrence: sulfasalazine and 5-aminosalicylic derivatives and the group of azathioprine/6-mercaptopurine. Although most clinical trials on the efficacy of sulfasalazine as maintenance therapy of Crohn's disease have given negative results, it could probably be favourably used in remission maintenance of Crohn's colitis. Controlled studies and two reviews have shown that 5-aminosalicylic derivatives are effective in reducing the risk of relapse. Ileitis and ileocolitis respond better than colitis. These drugs are also able to reduce the severity of lesions and of symptoms after surgery. 6-mercaptopurine and azathioprine can be used in more aggressive forms of the disease. The efficacy of this immuno-suppressive therapy is reported in over 70% of patients and the incidence of associated side effects is acceptable, but 6-mercaptopurine and azathioprine act slowly and the long latency period limits the usefulness of these drugs in some patients.