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The immediate goals of therapy are to improve this young woman’s symptoms of abdominal pain, diarrhea, weight loss, and fatigue. Equally important goals are to reduce the intestinal inflammation in hopes of preventing progression to intestinal stenosis, fistulization, and need for surgery. One option now is to step up her therapy by giving her a slow, tapering course of systemic corticosteroids (eg, prednisone) for 8–12 weeks in order to quickly bring her symptoms and inflammation under control while also initiating therapy with an immunomodulator (eg, azathioprine or mercap-topurine) in hopes of achieving long-term disease remis-sion. If satisfactory disease control is not achieved within 3–6 months, therapy with an anti-TNF agent would then be recommended. Alternatively, patients with moderate-to-severe Crohn’s disease who have failed mesalamine may be treated upfront with both an anti-TNF agent and immu-nomodulators, which achieves higher remission rates than either agent alone and may improve long-term outcomes.
Therapeutic & Toxic Potential of Over-the-Counter Agents
Valerie B. Clinard, PharmD, & Robin L. Corelli, PharmD