Maintenance and prophylactic therapy for Crohnʼs disease

Maintenance therapy for Crohnʼs disease continues to be a matter of discussion. Mesalamine appears to be effective in facilitating corticosteroid tapering immediately after an acute attack, but its long-term benefit remains controversial in the currently used dosage regimens. Budesonide 6 mg/d prolongs the time to relapse but does not offer much benefit as compared with placebo at 1 year. Only the classic immunosuppressives agents predictably maintain corticosteroidinduced remission. An interesting maintenance study from Italy renewed interest in ω-3 fatty acids as a maintenance drug in Crohnʼs disease. Further confirmation is needed, however, before it can be recommended as a valuable alternative to the current treatment regimens. Preventing recurrent Crohnʼs disease after surgical resection may even be more difficult than maintaining medically induced remission. Studies in this indication are difficult to perform given the limited numbers of patients and the long interval between surgery and clinical recurrence. Retrospective evidence that immunosuppressive agents may be useful was reported by French investigators. With mesalamine, high doses appear to be necessary and, given the marginal gain, the cost is considerable. Finally, budesonide has only been effective for Crohnʼs recurrence prevention in patients operated on for active disease.