داء كرون النشط المتوسط إلى الشديد لدى المرضى ذوي الخطر الأعلى عندما لم تُحقق الكورتيكوستيرويدات والعقاقير المناعية هدأة دائمة

References

• We recommend oral corticosteroids for short-term induction of remission in patients with moderately to severely active CD (strong recommendation, low level of evidence).
• Individuals are considered to have moderate–severe disease if they have not responded to treatment for mild–moderate disease or if they present with more prominent symptoms such as fever, significant weight loss, abdominal pain or tenderness, intermittent nausea or vomiting.
• We recommend anti-tumor necrosis factor (TNF) agents (intravenous infliximab, subcutaneous adalimumab, subcutaneous certolizumab pegol) for induction and maintenance of remission for moderately to severely active CD (strong recommendation, moderate level of evidence).
• We recommend combination therapy of intravenous infliximab with immunomodulators (thiopurines) as compared with treatment with either immunomodulators alone or intravenous infliximab alone in patients with CD who are naive to those agents (strong recommendation, moderate level of evidence).
• Regimens are generally chosen according to the patient's risk profile and disease severity with a goal to achieve clinical and biomarker response within 12 weeks of treatment initiation followed by durable steroid-free control of disease activity including both clinical and endoscopic remission.