Appropriateness of therapy for active Crohn's disease: results of a multidisciplinary International Expert Panel (EPACT II)

TitreAppropriateness of therapy for active Crohn's disease: results of a multidisciplinary International Expert Panel (EPACT II)
Publication TypeConference Paper
Year of Publication2009
AuthorsF. Pierre, M, Juillerat, P, Mottet, C, Pittet, V, Miquel, AGassull, Franz, JHeil, Gonvers, J-J, Vader, J-P, Froehlich, F, P. Christian, F
Conference NameAnnual meeting of the Swiss Society of Gastroenterology, Swiss Society for Visceral Surgery, Swiss Association for the Study of the Liver, Zürich (Switzerland), September 17/18, 2009
PublisherAGA Institute
Conference LocationMay 30-June 4, 2009, Chicago, IL
ISBN Number1424-7860
Accession Numberserval:BIB_CA18620A5A63
Mots-clésCrohn Disease, International Cooperation, Practice Guidelines as Topic

Introduction: The development of novel therapies and the increasing number of trials testing management strategies for luminal Crohn's disease (CD) have not filled all the gaps in our knowledge. Thus, in clinical practice, many decisions for CD patients need to be taken without high quality evidence. For this reason, a multidisciplinary European expert panel followed the RAND method to develop explicit criteria for the management of individual patients with active, steroid-dependent (ST-D) and steroid-refractory (ST-R) CD.
Methods: Twelve international experts convened in Geneva, Switzerland in December 2007, to rate explicit clinical scenarios, corresponding to real daily practice, on a 9-point scale according to the literature evidence and their own expertise. Median ratings were stratified into three categories: appropriate (7-9), uncertain (4-6) and inappropriate (1-3). Results: Overall, panelists rated 296 indications pertaining to mild-to-moderate, severe, ST-D, and ST-R CD. In anti-TNF naïve patients, budesonide and prednisone were found appropriate for mildmoderate CD, and infliximab (IFX) when those had previously failed or had not been tolerated. In patients with prior success with IFX, this drug with or without co-administration of a thiopurine analog was favored. Other anti-TNFs were appropriate in case of intolerance or resistance to IFX. High doses steroids, IFX or adalimumab were appropriate in severe active CD. Among 105 indications for ST-D or ST-R disease, the panel considered appropriate the thiopurine analogs, methotrexate, IFX, adalimumab and surgery for limited resection, depending on the outcome of prior therapies. Anti-TNFs were generally considered appropriate in ST-R.
Conclusion: Steroids, including budesonide for mild-to-moderate CD, remain first-line therapies in active luminal CD. Anti-TNFs, in particular IFX with respect to the amount of available evidence, remain second-line for most indications. Thiopurine analogs are preferred to anti-TNFs when steroids are not appropriate, except when anti-TNFs were previously successful. These recommendations are available online ( A prospective evaluation of these criteria in a large database in Switzerland in underway to validate these criteria.



Type : abstract

Volume : 139

Page : 16S



Citation Key / SERVAL ID3988
ÉtiquetteAGA Institute
Peer reviewRefereed


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