Download PDF
Z Gastroenterol 2003; 41(1): 31-35
DOI: 10.1055/s-2003-36665
Leitlinien der DGVS
© Karl Demeter Verlag im Georg Thieme Verlag Stuttgart · New York

Chronisch-aktiver Morbus Crohn

Chronically Active Crohn's DiseaseJ. Hoffmann1 , M. Zeitz1
  • 1Klinik für Gastroenterologie, Universitätsklinikum Benjamin Franklin, Berlin
Further Information

Publication History

Publication Date:
16 January 2003 (online)

Also available at
   Permissions and Reprints
Preview

Die Analyse der Studien zum chronisch aktiven Verlauf ist erschwert durch eine fehlende verbindliche und damit meist sehr variable Definition des chronisch aktiven Verlaufs. Ebenso ist eine Abgrenzung zu Studien zur Remissionserhaltung oft nicht möglich. Für zukünftige Studien ist daher eine international verbindliche Definition anzustreben.

Völlig ungeklärt ist die Frage, inwieweit eine initiale aggressive Immunsuppression bei M. Crohn den weiteren Verlauf günstig beeinflusst. Neue immunsuppressive Therapieansätze wie z. B. 6-Thioguanin oder Cyclophosphamid sind Gegenstand laufender Untersuchungen und sollten derzeit außerhalb von Studien nicht zum Einsatz kommen.

Bezüglich des Nebenwirkungsprofils von Immunsuppressiva liegen umfangreiche Erfahrungen auch aus anderen Fachgebieten (z. B. Rheumatologie) vor. Leitlinien aus diesen Bereichen haben, soweit sinnvoll, Eingang in die Empfehlungen zur Überwachung der Therapie des chronisch aktiven Verlaufes des M. Crohn gefunden.

Literatur

  • 1 Wright J P, Young G O, Tigler Wybrandi N. Predictors of acute relapse of Crohn’s disease. A laboratory and clinical study.  Dig Dis Sci. 1987;  32 164-170 (III)
    Search in Google Scholar
  • 2 Sandborn W, Sutherland L, Pearson D. et al . Azathioprine or 6-mercaptopurine for inducing remission of Crohn’s disease.  Cochrane Database Syst Rev. 2000;  2 (Ia)
    Search in Google Scholar
  • 3 Pearson D C, May G R, Fick G. et al . Azathioprine for maintaining remission of Crohn’s disease.  Cochrane Database Syst Rev. 2000;  2 (Ia)
    Search in Google Scholar
  • 4 Feagan B G, Rochon J, Fedorak R N. et al . Methotrexate for the treatment of Crohn’s disease. The North American Crohn’s Study Group Investigators.  N Engl J Med. 1995;  332 (5) 292-297 (Ib)
    Search in Google Scholar
  • 5 Mate-Jimenez J, Hermida C, Cantero-Perona J. et al . 6-mercaptopurine or methotrexate added to prednisone induces and maintains remission in steroid-dependent inflammatory bowel disease.  Eur J Gastroenterol Hepatol. 2000;  12 (11) 1227-1233 (Ib)
    Search in Google Scholar
  • 6 Stack W A, Mann S D, Roy A J. et al . Randomised controlled trial of CDP571 antibody to tumour necrosis factor-alpha in Crohn’s disease.  Lancet. 1997;  349 (9051) 521-524 (Ib)
    Search in Google Scholar
  • 7 Targan S R, Hanauer S B, van Deventer S J. et al . A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn’s disease. Crohn’s Disease cA2 Study Group.  N Engl J Med. 1997;  337 (15) 1029-1035 (Ib)
    Search in Google Scholar
  • 8 Schreiber S, Campieri M, Colombel J F. et al . Use of anti-tumour necrosis factor agents in inflammatory bowel disease. European guidelines for 2001-2003.  Int J Colorectal Dis. 2001;  16 (1) 1-11; discussion 12-13 (IV)
    Search in Google Scholar
  • 9 Keane J, Gershon S, Wise R P. et al . Tuberculosis associated with infliximab, a tumor necrosis factor alpha- neutralizing agent.  N Engl J Med. 2001;  345 (15) 1098-1104 (III)
    Search in Google Scholar
  • 10 Markowitz J, Grancher K, Kohn N. et al . A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn’s disease.  Gastroenterology. 2000;  119 (4) 895-902 (Ib)
    Search in Google Scholar
  • 11 Sandborn W J, Tremaine W J, Wolf D C. et al . Lack of effect of intravenous administration on time to respond to azathioprine for steroid-treated Crohn’s disease. North American Azathioprine Study Group.  Gastroenterology. 1999;  117 (3) 527-535 (Ib)
    Search in Google Scholar
  • 12 Boulton-Jones J R, Pritchard K, Mahmoud A A. The use of 6-mercaptopurine in patients with inflammatory bowel disease after failure of azathioprine therapy.  Aliment Pharmacol Ther. 2000;  14 (12) 1561-1565 (IV)
    Search in Google Scholar
  • 13 Armstrong V W, Oellerich M. New developments in the immunosuppressive drug monitoring of cyclosporine, tacrolimus, and azathioprine.  Clin Biochem. 2001;  34 (1) 9-16 (IV)
    Search in Google Scholar
  • 14 Bouhnik Y, Lemann M, Mary J Y. et al . Long-term follow-up of patients with Crohn’s disease treated with azathioprine or 6-mercaptopurine.  Lancet. 1996;  347 (8996) 215-219 (IV)
    Search in Google Scholar
  • 15 Ramsey-Goldman R, Mientus J M, Kutzer J E. et al . Pregnancy outcome in women with systemic lupus erythematosus treated with immunosuppressive drugs.  J Rheumatol. 1993;  20 (7) 1152-1157 (IIb)
    Search in Google Scholar
  • 16 Rajapakse R O, Korelitz B I, Zlatanic J. et al . Outcome of pregnancies when fathers are treated with 6-mercaptopurine for inflammatory bowel disease.  Am J Gastroenterol. 2000;  95 (3) 684-688 (III)
    Search in Google Scholar
  • 17 Kremer J M, Alarcon G S, Lightfoot R W Jr. et al . Methotrexate for rheumatoid arthritis. Suggested guidelines for monitoring liver toxicity. American College of Rheumatology.  Arthritis Rheum. 1994;  37 (3) 316-328 (IV)
    Search in Google Scholar
  • 18 Erickson A R, Reddy V, Vogelgesang S A. et al . Usefulness of the American College of Rheumatology recommendations for liver biopsy in methotrexate-treated rheumatoid arthritis patients.  Arthritis Rheum. 1995;  38 (8) 1115-1119 (IV)
    Search in Google Scholar
  • 19 Alarcon G S, Kremer J M, Macaluso M. et al . Risk factors for methotrexate-induced lung injury in patients with rheumatoid arthritis. A multicenter, case-control study. Methotrexate-Lung Study Group.  Ann Intern Med. 1997;  127 (5) 356-364 (III)
    Search in Google Scholar
  • 20 Arthritis Clinical Trial Archive Group Rheumatoid. The effect of age and renal function on the efficacy and toxicity of methotrexate in rheumatoid arthritis.  J Rheumatol. 1995;  22 (2) 218-223 (III)
    Search in Google Scholar
  • 21 Feagan B G, Fedorak R N, Irvine E J. et al . A comparison of methotrexate with placebo for the maintenance of remission in Crohn’s disease. North American Crohn’s Study Group Investigators.  N Engl J Med. 2000;  342 (22) 1627-1632 (Ib)
    Search in Google Scholar
  • 22 Mack D R, Young R, Kaufman S S. et al . Methotrexate in patients with Crohn’s disease after 6-mercaptopurine.  J Pediatr. 1998;  132 (5) 830-835 (IV)
    Search in Google Scholar
  • 23 Ortiz Z, Shea B, Suarez A lmazor M. et al . Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis.  Cochrane Database Syst Rev. 2000;  2 (Ia)
    Search in Google Scholar
  • 24 Neurath M F, Wanitschke R, Peters M. et al . Randomised trial of mycophenolate mofetil versus azathioprine for treatment of chronic active Crohn’s disease.  Gut. 1999;  44 (5) 625-628 (Ib)
    Search in Google Scholar
  • 25 Fellermann K, Steffen M, Stein J. et al . Mycophenolate mofetil: lack of efficacy in chronic active inflammatory bowel disease.  Aliment Pharmacol Ther. 2000;  14 (2) 171-176 (IV)
    Search in Google Scholar
  • 26 Hassard P V, Vasiliauskas E A, Kam L Y. et al . Efficacy of mycophenolate mofetil in patients failing 6-mercaptopurine or azathioprine therapy for Crohn’s disease.  Inflamm Bowel Dis. 2000;  6 (1) 16-20 (IV)
    Search in Google Scholar
  • 27 Hyams J S, Markowitz J, Wyllie R. Use of infliximab in the treatment of Crohn’s disease in children and adolescents.  J Pediatr. 2000;  137 (2) 192-196 (IV)
    Search in Google Scholar
  • 28 Rutgeerts P, D’Haens G, Targan S. et al . Efficacy and safety of retreatment with anti-tumor necrosis factor antibody (infliximab) to maintain remission in Crohn’s disease.  Gastroenterology. 1999;  117 (4) 761-769 (Ib)
    Search in Google Scholar
  • 29 Sandborn W J, Hanauer S B, Katz S. et al . Etanercept for active Crohn’s disease: a randomized, double-blind, placebo-controlled trial.  Gastroenterology. 2001;  121 (5) 1088-1094 (Ib)
    Search in Google Scholar
  • 30 Hanauer S B, Feagan B G, Lichtenstein G R. et al . Maintenance infliximab therapy for the treatment of Crohn’s disease.  Lancet. 2002;  359 (9317) 1541-1549 (Ib)
    Search in Google Scholar
  • 31 Stange E F, Modigliani R, Pena A S. et al . European trial of cyclosporine in chronic active Crohn’s disease: a 12-month study.  Gastroenterology. 1995;  109 774-782 (Ib)
    Search in Google Scholar
  • 32 Camma C, Giunta M, Rosselli M. et al . Mesalamine in the maintenance treatment of Crohn’s disease: a meta-analysis adjusted for confounding variables.  Gastroenterology. 1997;  113 (5) 1465-1473 (Ia)
    Search in Google Scholar
  • 33 Cottone M, Camma C. Mesalamine and relapse prevention in Crohn’s disease.  Gastroenterology. 2000;  119 (2) 597 (Ia)
    Search in Google Scholar
  • 34 Steinhart A H, Ewe K, Griffiths A M. et al . Corticosteroids for maintaining remission of Crohn’s disease (Cochrane Review).  Cochrane Database Syst Rev. 2001;  3 (Ia)
    Search in Google Scholar
  • 35 Simms L, Steinhart A H. Budesonide for maintenance of remission in Crohn’s disease.  Cochrane Database Syst Rev. 2001;  4 (Ia)
    Search in Google Scholar
  • 36 Rutgeerts P, Hiele M, Geboes K. et al . Controlled trial of metronidazole treatment for prevention of Crohn’s recurrence after ileal resection.  Gastroenterology. 1995;  108 (6) 1617 (Ib)
    Search in Google Scholar