JAAPA. 2024 May 1;37(5):1-5. doi: 10.1097/01.JAA.0000000000000013.Epub 2024 Apr 25.

Erin Martin ¹, Catherine K Sadowski

Author information

¹At the time this article was written, Erin Martin was a student in the PA program at Mercer University in Atlanta, Ga. She now practices at Resurgens Orthopaedics in Atlanta, Ga., specializing in shoulder and elbow. Catherine K. Sadowski is a clinical associate professor in the PA program at Mercer University. The authors have disclosed no potential conflicts of interest, financial or otherwise.

Abstract

Traditionally, medical providers have used the step-up approach to manage patients with Crohn disease, starting with 5-aminosalicylic acid derivatives, progressing to corticosteroids, and eventually to immunomodulators and biologics. However, a new top-down approach focuses on early and aggressive therapy with biologics and immunomodulators to reduce the rate of mucosal and intestinal damage. This article describes early and aggressive biologic and immunomodulator therapies and new therapeutic parameters compared with traditional step-up treatment for patients with Crohn disease.