CorticosteroidsandimmunomodulatorshavebeenthemainstaytherapiesforCrohn’sdisease.Corticosteroidsarehighlyeffectivetocontrolsymptomsintheshort-term,buttheyarenoteffectiveinmaintainingremission,theyhealthemucosainareducedproportionofcases,andlong-timeexposureisassociatedwithanincreasedriskofinfectionsandmortality.Immunomodulators,azathioprineandmethotrexate,healthemucosainahigherproportionofpatientsthatcorticosteroidsbuttheironsetofactionisslowandtheybenefitlessthanhalfofpatientswithCrohn’sdisease.Inthelastdecade,medicaltherapyforCrohn’sdiseasehasexperiencedaremarkablechangeduetotheintroductionofbiologictherapy,andparticularlytheuseofanti-tumournecrosisfactor-alphaagents.Infliximab,adalimumab,andcertolizumabpegolhavedemonstratedefficacyforinductionandmaintenanceofremissioninactiveCrohn’sdisease.TheseagentshaveraisedthebarforwhatisasuitablesymptomaticresponseinCrohn’sdiseaseandmodificationofthenaturalhistoryofthediseasehasbecomeamajorgoalinthetreatmentofCrohn’sdisease.Thereareseveraldataintheliteraturethatsuggestthatearlyuseofbiologictherapyandachievementofmucosalhealingcontributetodiseasecoursemodification.However,manyquestionsonearlybiologicaltherapyforCrohn’sdiseaseremainstillunanswered.
