Overview of pharmacotherapy for Crohn disease 

[13][20]

Indication Substance class Substances

 Loperamide
 Antidiarrheal agents
 Bile acid binders
Symptomatic treatment
 Topical corticosteroids  Triamcinolone

 Topical 5-aminosalicylic acid derivatives (5-ASAs) (e.g., suppository, foam, enema)

 Topical corticosteroids  Oral budesonide 
Mild-to-moderate d
isease 
 Sulfonamides  Sulfasalazine 

 First-line: oral corticosteroids  Prednisone

 Azathioprine
 Steroid-sparing: thiopurine analogs
Moderate-to-severe   6-Mercaptopurine
disease 
Acute  Alternatively  Ustekinumab (anti-p40 antibody)
episode o Anti-p40 antibodies  Natalizumab, vedolizumab (alpha
o Alpha 4 integrin inhibitors 4 integrin inhibitors)

Severe/fulminant
 First-line: IV corticosteroids  Methylprednisolone
disease 

 Infliximab, adalimumab, certolizumab (TNF-
Steroid-refractory d  First-line: TNF-α antibodies, if necessary α antibodies)
isease in combination with thiopurine analogs  If necessary: azathioprine (or 6-
mercaptopurine) 

Maintenance therapy  Choice of substance depends on which agent  Azathioprine, 6-mercaptopurine (thiopurine

was used to induce remission analogs)
 Corticosteroids are contraindicated for  Methotrexate (antimetabolite)
maintenance.  Infliximab, adalimumab, certolizumab (TNF-α 
Overview of pharmacotherapy for Crohn disease [13][20]

Indication Substance class Substances

 5-ASA/sulfasalazine have proven to be
inefficient. [21]
 The following substance classes are available: antibodies)
o Thiopurine analogs  Ustekinumab (anti-p40 antibody)
o Antimetabolites  Natalizumab, vedolizumab (alpha
o TNF-α antibodies 4 integrin inhibitors)
o Anti-p40 antibody
o Alpha 4 integrin inhibitors