A Look at Current Management Options
Currently available pharmacologic agents for CD fall into 5 classes―aminosalicylates, corticosteroids, antibiotics, immunomodulators, and biologics.^8,11-13 Treatment selection is based on the anatomic location and severity of the disease and the presence of extraintestinal complications. In addition, other factors, such as therapy-induced complications, functional ability, social and emotional support and resources, and patient disease education, may also factor into treatment decisions.^4,8,11
   
Knowledge of the anatomic location of disease is important, particularly for agents (eg, mesalamine, sulfasalazine, budesonide, and antibiotics) that target specific areas of the GI tract. For systemic agents that target the entire GI tract, the anatomic location of disease is not as important, although combination treatment approaches are often employed (eg, addition of topical rectal therapies to systemic therapies).⁴
   
Disease severity can be complicated to define because of the heterogeneous nature of CD as well as its varied anatomic locations and extraintestinal complications; there is currently no “gold standard” for the measurement of disease severity.⁴ In clinical trials, the Crohn’s Disease Activity Index (CDAI) has been adopted as a standardized instrument to measure disease severity,^14,15 but this index has been poorly adopted in clinical practice. In the latter setting, a symptom-based classification is preferred (Table 2).²

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