Skip to main content
Home
Zeitschriften
Zeitungen
Podcast
Gesundheitspolitik
Praxis
Allerlei
Jobs
Fachgebiete
Allgemeinmedizin Anästhesiologie & Intensivmedizin Apotheke Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kinder & Jugendheilkunde Neurologie & Psychiatrie Orthopädie & Unfallchirurgie Pflege Urologie Zahnmedizin
Subfächer Innere Medizin
Diabetologie Gastroenterologie Infektiologie Kardiologie Onkologie und Hämatologie Pneumologie Rheumatologie
Fortbildungen
Überblick Fortbildungen DFP-Literaturstudium-Artikel DFP-Webcast Fortbildungen DFP-Podcasts
Erweiterte Suche
Anmelden
nach oben
Schweizer Gastroenterologie
Erschienen in:

14.05.2020 | Morbus Crohn | Originalien

Therapiealgorithmen für die Behandlung des Morbus Crohn im klinischen Alltag

verfasst von: PD Dr. med. Michael Christian Sulz, Joel Duetschler, Frank Seibold

Erschienen in: Schweizer Gastroenterologie | Ausgabe 2/2020

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die Therapie des oft schubförmig verlaufenden und nicht heilbaren Morbus Crohn ist komplex und sollte auf den einzelnen Patienten individuell abgestimmt werden. Gerade komplizierte Verläufe (z. B. mit komplexer perianaler Fistelbildung) sind anspruchsvolle Situationen im klinischen Alltag. Das medikamentöse Therapiearmamentarium wurde in den letzten Jahren durch neue Wirkstoffe erweitert, die nun auch in den internationalen Richtlinien positioniert werden. Trotz der individualisierten Therapie ist es im klinischen Alltag hilfreich, Algorithmen zur besseren Entscheidungsfindung beiziehen zu können. In dieser Arbeit werden 3 Algorithmen zu verschiedenen klinischen Szenarien in der Therapie des Morbus Crohn mit dem Fokus auf die endoluminale Inflammation präsentiert und die neuen Therapieoptionen in diesen Algorithmen positioniert.
Vorheriger Artikel Aktueller Stand des Kolonkarzinomscreenings (Fokus auf Stuhltest)
Nächster Artikel COVID-19 aus der Sicht der Gastroenterologie
Literatur
1.
Crohn BB, Ginzburg L, Oppenheimer GD (2000) Regional ileitis: a pathologic and clinical entity. 1932. Mt Sinai J Med 67(3):263–268PubMed
2.
Stark R, König HH, Leidl R (2006) Costs of inflammatory bowel disease in Germany. PharmacoEconomics 24(8):797–814PubMed
3.
Satsangi J, Silverberg MS, Vermeire S et al (2006) The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut 55(6):749–753PubMedPubMedCentral
4.
Maaser C, Sturm A, Vavricka SR et al (2019) ECCO-ESGAR guideline for diagnostic assessment in IBD part 1: initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis 13(2):144–164PubMed
5.
Burri E, Beglinger C (2014) The use of fecal calprotectin as a biomarker in gastrointestinal disease. Expert Rev Gastroenterol Hepatol 8(2):197–210PubMed
6.
Beaugerie L, Sokol H (2012) Clinical, serological and genetic predictors of inflammatory bowel disease course. World J Gastroenterol 18(29):3806–3813PubMedPubMedCentral
7.
Torres J, Bonovas S, Doherty G et al (2020) ECCO guidelines on therapeutics in Crohn’s disease: medical treatment. J Crohns Colitis 14(1):4–22PubMed
8.
Michetti P, Weinman J, Mrowietz U et al (2017) Impact of treatment-related beliefs on medication adherence in immune-mediated inflammatory diseases: results of the global ALIGN study. Adv Ther 34(1):91–108PubMed
9.
Gomollón F, Dignass A, Annese V et al (2017) 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 1: diagnosis and medical management. J Crohns Colitis 11(1):3–25PubMed
10.
Gionchetti P, Dignass A, Danese S et al (2017) 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 2: surgical management and special situations. J Crohns Colitis 11(2):135–149PubMed
11.
12.
13.
Colombel JF, D’Haens G, Lee WJ et al (2020) Outcomes and strategies to support a treat-to-target approach in inflammatory bowel disease: a systematic review. J Crohns Colitis 14(2):254–266PubMed
14.
Bouguen G, Levesque BG, Pola S et al (2014) Endoscopic assessment and treating to target increase the likelihood of mucosal healing in patients with Crohn’s disease. Clin Gastroenterol Hepatol 12(6):978–985PubMed
15.
Peyrin-Biroulet L, Sandborn W, Sands BE et al (2015) Selecting therapeutic targets in inflammatory bowel disease (STRIDE): determining therapeutic goals for treat-to-target. Am J Gastroenterol 110(9):1324–1338PubMed
16.
Darr U, Khan N (2017) Treat to target in inflammatory bowel disease: an updated review of literature. Curr Treat Options Gastroenterol 15(1):116–125PubMed
17.
Bryant RV, Winer S, Travis SP et al (2014) Systematic review: histological remission in inflammatory bowel disease. Is ‘complete’ remission the new treatment paradigm? An IOIBD initiative. J Crohns Colitis 8(12):1582–1597PubMed
18.
Nielsen OH, Ainsworth MA (2013) Tumor necrosis factor inhibitors for inflammatory bowel disease. N Engl J Med 369(8):754–762PubMed
19.
Hanauer SB, Feagan BG, Lichtenstein GR et al (2002) Maintenance infliximab for Crohn’s disease: the ACCENT I randomised trial. Lancet 359(9317):1541–1549PubMed
20.
D’Haens G, Van Deventer S, Van Hogezand R et al (1999) Endoscopic and histological healing with infliximab anti-tumor necrosis factor antibodies in Crohn’s disease: a European multicenter trial. Gastroenterology 116(5):1029–1034PubMed
21.
Ben-Horin S, Kopylov U, Chowers Y (2014) Optimizing anti-TNF treatments in inflammatory bowel disease. Autoimmun Rev 13(1):24–30PubMed
22.
Fine S, Papamichael K, Cheifetz AS (2019) Etiology and management of lack or loss of response to anti-tumor necrosis factor therapy in patients with inflammatory bowel disease. Gastroenterol Hepatol (N Y) 15(12):656–665
23.
Adegbola SO, Sahnan K, Warusavitarne J et al (2018) Anti-TNF therapy in Crohn’s disease. Int J Mol Sci 19(8):2244PubMedCentral
24.
Yarur AJ, Rubin DT (2015) Therapeutic drug monitoring of anti-tumor necrosis factor agents in patients with inflammatory bowel diseases. Inflamm Bowel Dis 21(7):1709–1718PubMed
25.
Poggioli G, Laureti S, Campieri M et al (2007) Infliximab in the treatment of Crohn’s disease. Ther Clin Risk Manag 3(2):301–308PubMedPubMedCentral
26.
Rutgeerts P, Van Assche G, Vermeire S (2004) Optimizing anti-TNF treatment in inflammatory bowel disease. Gastroenterology 126(6):1593–1610PubMed
27.
Rahier JF, Magro F, Abreu C et al (2014) Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis 8(6):443–468PubMed
28.
Wong SH, Gao Q, Tsoi KK et al (2016) Effect of immunosuppressive therapy on interferon γ release assay for latent tuberculosis screening in patients with autoimmune diseases: a systematic review and meta-analysis. Thorax 71(1):64–72PubMed
29.
Shukla T, Sands BE (2019) Novel non-biologic targets for inflammatory bowel disease. Curr Gastroenterol Rep 21(5):22PubMed
30.
Weisshof R, El Jurdi K, Zmeter N et al (2018) Emerging therapies for inflammatory bowel disease. Adv Ther 35(11):1746–1762PubMedPubMedCentral
31.
Sandborn WJ, Feagan BG, Rutgeerts P et al (2013) Vedolizumab as induction and maintenance therapy for Crohn’s disease. N Engl J Med 369(8):711–721PubMed
32.
Christensen B, Colman RJ, Micic D et al (2018) Vedolizumab as induction and maintenance for inflammatory bowel disease: 12-month effectiveness and safety. Inflamm Bowel Dis 24(4):849–860PubMedPubMedCentral
33.
Baumgart DC, Bokemeyer B, Drabik A et al (2016) Vedolizumab Germany consortium. Vedolizumab induction therapy for inflammatory bowel disease in clinical practice—a nationwide consecutive German cohort study. Aliment Pharmacol Ther 43(10):1090–1102PubMed
34.
Danese S, Sandborn WJ, Colombel JF et al (2019) Endoscopic, radiologic, and histologic healing with vedolizumab in patients with active Crohn’s disease. Gastroenterology 157(4):1007–1018.e7PubMed
35.
36.
Loftus EV, Colombel J‑F, Feagan BG et al (2019) Long-term safety of vedolizumab in ulcerative colitis and Crohn’s disease: final results from the GEMINI LTS study. Gastroenterology 156(6):182
37.
Ng SC, Hilmi IN, Blake A et al (2018) Low frequency of opportunistic infections in patients receiving vedolizumab in clinical trials and post-marketing setting. Inflamm Bowel Dis 24(11):2431–2441PubMedPubMedCentral
38.
Tarabar D, Hirsch A, Rubin DT (2016) Vedolizumab in the treatment of Crohn’s disease. Expert Rev Gastroenterol Hepatol 10(3):283–290PubMed
39.
Sandborn WJ, Gasink C, Gao LL et al (2012) Ustekinumab induction and maintenance therapy in refractory Crohn’s disease. N Engl J Med 367(16):1519–1528PubMed
40.
MacDonald JK, Nguyen TM, Khanna R et al (2016) Anti-IL-12/23p40 antibodies for induction of remission in Crohn’s disease. Cochrane Database Syst Rev 11:CD7572PubMed
41.
Engel T, Yung DE, Ma C et al (2019) Effectiveness and safety of ustekinumab for Crohn’s disease; systematic review and pooled analysis of real-world evidence. Dig Liver Dis 51(9):1232–1240PubMed
42.
Feagan BG, Sandborn WJ, Gasink C et al (2016) Ustekinumab as induction and maintenance therapy for Crohn’s disease. N Engl J Med 375(20):1946–1960PubMed
43.
Tillack C, Ehmann LM, Friedrich M et al (2014) Anti-TNF antibody-induced psoriasiform skin lesions in patients with inflammatory bowel disease are characterised by interferon-γ-expressing Th1 cells and IL-17A/IL-22-expressing Th17 cells and respond to anti-IL-12/IL-23 antibody treatment. Gut 63(4):567–577PubMed
44.
45.
Burri E, Juillerat P, Maillard MH et al (2019) Position statement on the use of biosimilars in inflammatory bowel disease. Swiss Med Wkly 149:w20148PubMed
46.
Danese S, Fiorino G, Raine T et al (2017) ECCO position statement on the use of biosimilars for inflammatory bowel disease—an update. J Crohns Colitis 11(1):26–34PubMed
47.
van der Woude CJ, Ardizzone S, Bengtson MB et al (2015) The second European evidenced-based consensus on reproduction and pregnancy in inflammatory bowel disease. J Crohns Colitis 9(2):107–124PubMed
48.
Reddy D, Murphy SJ, Kane SV et al (2008) Relapses of inflammatory bowel disease during pregnancy: in-hospital management and birth outcomes. Am J Gastroenterol 103(5):1203–1209PubMed
49.
50.
51.
Chung ES, Packer M, Lo KH et al (2003) Anti-TNF therapy against congestive heart failure investigators. Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: results of the anti-TNF therapy against congestive heart failure (ATTACH) trial. Circulation 107(25):3133–3140PubMed
52.
Kalman RS, Hartshorn K, Farraye FA (2015) Does a personal or family history of malignancy preclude the use of immunomodulators and biologics in IBD. Inflamm Bowel Dis 21(2):428–435PubMed
53.
Osterman MT, Sandborn WJ, Colombel JF et al (2014) Increased risk of malignancy with adalimumab combination therapy, compared with monotherapy, for Crohn’s disease. Gastroenterology 146(4):941–949PubMed
54.
Long MD, Martin CF, Pipkin CA et al (2012) Risk of melanoma and nonmelanoma skin cancer among patients with inflammatory bowel disease. Gastroenterology 143(2):390–399.e1PubMed
55.
Siegel CA, Marden SM, Persing SM et al (2009) Risk of lymphoma associated with combination anti-tumor necrosis factor and immunomodulator therapy for the treatment of Crohn’s disease: a meta-analysis. Clin Gastroenterol Hepatol 7(8):874–881PubMedPubMedCentral
56.
Beaugerie L (2013) Use of immunosuppressants and biologicals in patients with previous cancer. Dig Dis 31(2):254–259PubMed
57.
Rezaie A, Kuenzig ME, Benchimol EI et al (2015) Budesonide for induction of remission in Crohn’s disease. Cochrane Database Syst Rev 6:CD296
58.
Kuenzig ME, Rezaie A, Kaplan GG et al (2018) Budesonide for the induction and maintenance of remission in Crohn’s disease: systematic review and meta-analysis for the Cochrane collaboration. J Can Assoc Gastroenterol 1(4):159–173PubMedPubMedCentral
59.
60.
Coward S, Kuenzig ME, Hazlewood G et al (2017) Comparative effectiveness of mesalamine, sulfasalazine, corticosteroids, and budesonide for the induction of remission in Crohn’s disease: a Bayesian network meta-analysis: republished. Inflamm Bowel Dis 23(5):E26–E37PubMed
61.
Benchimol EI, Seow CH, Steinhart AH et al (2008) Traditional corticosteroids for induction of remission in Crohn’s disease. Cochrane Database Syst Rev 2:CD6792
62.
Gionchetti P, Rizzello F, Annese V et al (2017) Use of corticosteroids and immunosuppressive drugs in inflammatory bowel disease: clinical practice guidelines of the Italian group for the study of inflammatory bowel disease. Dig Liver Dis 49(6):604–617PubMed
63.
Vavricka SR, Schoepfer AM, Scharl M et al (2014) Steroid use in Crohn’s disease. Drugs 74(3):313–324PubMed
64.
Prefontaine E, Macdonald JK, Sutherland LR (2009) Azathioprine or 6‑mercaptopurine for induction of remission in Crohn’s disease. Cochrane Database Syst Rev 4:CD545
65.
Lichtenstein GR, Loftus EV, Isaacs KL et al (2018) ACG clinical guideline: management of Crohn’s disease in adults. Am J Gastroenterol 113(4):481–517PubMed
66.
Rutgeerts PJ (2001) Review article: the limitations of corticosteroid therapy in Crohn’s disease. Aliment Pharmacol Ther 15(10):1515–1525PubMed
67.
Tsui JJ, Huynh HQ (2018) Is top-down therapy a more effective alternative to conventional step-up therapy for Crohn’s disease? Ann Gastroenterol 31(4):413–424PubMedPubMedCentral
68.
D’Haens GR, Panaccione R, Higgins PD et al (2011) The London position statement of the world congress of gastroenterology on biological therapy for IBD with the European Crohn’s and colitis organization: when to start, when to stop, which drug to choose, and how to predict response? Am J Gastroenterol 106(2):199–212 (quiz 213)PubMed
69.
Colombel JF, Sandborn WJ, Rutgeerts P et al (2007) Adalimumab for maintenance of clinical response and remission in patients with Crohn’s disease: the CHARM trial. Gastroenterology 132(1):52–65PubMed
70.
Colombel JF, Sandborn WJ, Reinisch W et al (2010) Infliximab, azathioprine, or combination therapy for Crohn’s disease. N Engl J Med 362(15):1383–1395PubMed
71.
Bar-Yoseph H, Waterman M, Almog R et al (2017) Prevention of antidrug antibody formation to Infliximab in Crohn’s patients with prior failure of thiopurines. Clin Gastroenterol Hepatol 15(1):69–75PubMed
72.
Schreiber S (2011) Certolizumab pegol for the treatment of Crohn’s disease. Therap Adv Gastroenterol 4(6):375–389PubMedPubMedCentral
73.
Kucharzik T, Wittig BM, Helwig U et al (2017) Use of intestinal ultrasound to monitor Crohn’s disease activity. Clin Gastroenterol Hepatol 15(4):535–542.e2PubMed
74.
Ricciuto A, Dhaliwal J, Walters TD et al (2018) Clinical outcomes with therapeutic drug monitoring in inflammatory bowel disease: a systematic review with meta-analysis. J Crohns Colitis 12(11):1302–1315PubMed
75.
Steenholdt C, Brynskov J, Thomsen O et al (2014) Individualised therapy is more cost-effective than dose intensification in patients with Crohn’s disease who lose response to anti-TNF treatment: a randomised, controlled trial. Gut 63(6):919–927PubMed
76.
77.
Hendy P, Hart A, Irving P (2016) Anti-TNF drug and antidrug antibody level monitoring in IBD: a practical guide. Frontline Gastroenterol 7(2):122–128PubMed
78.
Jess T, Winther KV, Munkholm P et al (2002) Mortality and causes of death in Crohn’s disease: follow-up of a population-based cohort in Copenhagen county, Denmark. Gastroenterology 122(7):1808–1814PubMed
79.
Sandborn WJ, Fazio VW, Feagan BG et al (2003) American gastroenterological association clinical practice committee. AGA technical review on perianal Crohn’s disease. Gastroenterology 125(5):1508–1530PubMed
80.
Aguilera-Castro L, Ferre-Aracil C, Garcia-Garcia-de-Paredes A et al (2017) Management of complex perianal Crohn’s disease. Ann Gastroenterol 30(1):33–44PubMed
81.
Gecse KB, Bemelman W, Kamm MA et al (2014) A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn’s disease. Gut 63(9):1381–1392PubMed
82.
Adegbola SO, Pisani A, Sahnan K et al (2018) Medical and surgical management of perianal Crohn’s disease. Ann Gastroenterol 31(2):129–139PubMedPubMedCentral
83.
Wu XW, Ji HZ, Wang FY (2015) Meta-analysis of ciprofloxacin in treatment of Crohn’s disease. Biomed Rep 3(1):70–74PubMed
84.
Present DH, Rutgeerts P, Targan S et al (1999) Infliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med 340(18):1398–1405PubMed
85.
Lichtiger S, Binion DG, Wolf DC et al (2010) The CHOICE trial: adalimumab demonstrates safety, fistula healing, improved quality of life and increased work productivity in patients with Crohn’s disease who failed prior infliximab therapy. Aliment Pharmacol Ther 32(10):1228–1239PubMed
86.
Schreiber S, Lawrance IC, Thomsen O et al (2011) Randomised clinical trial: certolizumab pegol for fistulas in Crohn’s disease—subgroup results from a placebo-controlled study. Aliment Pharmacol Ther 33(2):185–193PubMed
87.
Jones JL, Kaplan GG, Peyrin-Biroulet L et al (2015) Effects of concomitant immunomodulator therapy on efficacy and safety of anti-tumor necrosis factor therapy for Crohn’s disease: a meta-analysis of placebo-controlled trials. Clin Gastroenterol Hepatol 13(13):2233–2240.e1‑2 (quiz e177-8)PubMed
88.
Lee MJ, Parker CE, Taylor SR et al (2018) Efficacy of medical therapies for fistulizing Crohn’s disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol 16(12):1879–1892PubMed
89.
90.
Ciccocioppo R, Klersy C, Leffler DA et al (2019) Systematic review with meta-analysis: safety and efficacy of local injections of mesenchymal stem cells in perianal fistulas. JGH Open 3(3):249–260PubMedPubMedCentral
91.
Pascua M, Su C, Lewis JD et al (2008) Meta-analysis: factors predicting post-operative recurrence with placebo therapy in patients with Crohn’s disease. Aliment Pharmacol Ther 28(5):545–556PubMed
92.
Connelly TM, Messaris E (2014) Predictors of recurrence of Crohn’s disease after ileocolectomy: a review. World J Gastroenterol 20(39):14393–14406PubMedPubMedCentral
93.
Rutgeerts P, Geboes K, Vantrappen G et al (1990) Predictability of the postoperative course of Crohn’s disease. Gastroenterology 99(4):956–963PubMed
94.
Lamb CA, Kennedy NA, Raine T et al (2019) British society of gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut 68(3):s1–s106PubMed
95.
Vaughn BP, Moss AC (2014) Prevention of post-operative recurrence of Crohn’s disease. World J Gastroenterol 20(5):1147–1154PubMedPubMedCentral
96.
Reese GE, Nanidis T, Borysiewicz C et al (2008) The effect of smoking after surgery for Crohn’s disease: a meta-analysis of observational studies. Int J Colorectal Dis 23(12):1213–1221PubMed
97.
Cosnes J, Carbonnel F, Beaugerie L et al (1996) Effects of cigarette smoking on the long-term course of Crohn’s disease. Gastroenterology 110(2):424–431PubMed
98.
Ryan WR, Allan RN, Yamamoto T et al (2004) Crohn’s disease patients who quit smoking have a reduced risk of reoperation for recurrence. Am J Surg 187(2):219–225PubMed
99.
Rutgeerts P, Hiele M, Geboes K et al (1995) Controlled trial of metronidazole treatment for prevention of Crohn’s recurrence after ileal resection. Gastroenterology 108(6):1617–1621PubMed
100.
Nguyen GC, Loftus EV, Hirano I et al (2017) American gastroenterological association institute guideline on the management of Crohn’s disease after surgical resection. Gastroenterology 152(1):271–275PubMed
101.
Mowat C, Arnott I, Cahill A et al (2016) Mercaptopurine versus placebo to prevent recurrence of Crohn’s disease after surgical resection (TOPPIC): a multicentre, double-blind, randomised controlled trial. Lancet Gastroenterol Hepatol 1(4):273–282PubMedPubMedCentral
102.
Regueiro M, Feagan BG, Zou B et al (2016) Infliximab reduces endoscopic, but not clinical, recurrence of Crohn’s disease after Ileocolonic resection. Gastroenterology 150(7):1568–1578PubMed
103.
Iheozor-Ejiofor Z, Gordon M, Clegg A et al (2019) Interventions for maintenance of surgically induced remission in Crohn’s disease: a network meta-analysis. Cochrane Database Syst Rev 9:CD13210PubMed
Metadaten
Titel
Therapiealgorithmen für die Behandlung des Morbus Crohn im klinischen Alltag
verfasst von
PD Dr. med. Michael Christian Sulz
Joel Duetschler
Frank Seibold
Publikationsdatum
14.05.2020
Verlag
Springer Vienna
Schlagwort
Morbus Crohn
Erschienen in
Schweizer Gastroenterologie / Ausgabe 2/2020
Print ISSN: 2662-7140
Elektronische ISSN: 2662-7159
DOI
https://doi.org/10.1007/s43472-020-00009-9

Weitere Artikel der Ausgabe 2/2020

Editoriale

  • Editoriale

Éditorial

  • Éditorial

Update zum Kolonkarzinomscreening

Perorale endoskopische Myotomie vs. pneumatische Dilatation in der Behandlung der Achalasie

  • Journal Club

Management der Hyperferritinämie

  • Originalien

COVID-19 aus der Sicht der Gastroenterologie

  • Aktuelles
Bildnachweise