Treatment of CD

Drug and dosing guidelines based on disease severity and location are presented in Table 19-5.

Mild to Moderate Active CD

© Induction of remission of mild to moderate active CD may be accomplished with oral aminosalicylates or budesonide. Sulfasalazine 4 to 6 g/day is most effective for patients with active colonic or ileocolonic involvement, with response rates of approx-

imately 50%. ' ' Mesalamine products have shown more variable results but may be

2,37

used for patients with ileal, ileocolonic, or colonic CD. ' These drugs are typically better tolerated than sulfasalazine at full treatment doses. Induction of remission may

require up to 16 weeks of treatment at full doses.

Budesonide 9 mg orally once daily for up to 8 weeks may be used for mild to moderate active CD in patients with involvement of the terminal ileum or ascending colon,

23 24 37

with success expected in 50% to 69% of patients. ' ' Because the formulation releases budesonide in the terminal ileum, it is not effective in reaching sites distal to 24,37

the ascending colon. ' Conventional oral corticosteroids such as prednisone and methylprednisolone may be used for patients who are unresponsive to aminosalicyl-ates or budesonide.

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