ECCO guidelines on therapeutics in Crohn's disease: medical treatment
Open accessAbstract
Crohn’s disease [CD] is a chronic inflammatory bowel disease [IBD] that can result in progressive bowel damage and disability.1 CD can affect individuals of any age, from children to the elderly,2,3 and may cause significant morbidity and impact on quality of life. Up to one-third of patients present with complicated behaviour [strictures, fistula, or abscesses] at diagnosis.4 Most patients over time will develop a complication, with roughly 50% of patients requiring surgery within 10 years of diagnosis.5–7 As the precise aetiology of CD remains unknown, a curative therapy is not yet available.8 Several agents are available for the medical treatment of CD. Medical agents include mesalazine [5-ASA], locally active steroids [such as budesonide], systemic steroids, thiopurines such as azathioprine [AZA] and mercaptopurine [MP], methotrexate [MTX], and biologic therapies (such as anti-tumour necrosis factor [TNF], anti-integrins, and anti-interleukin [IL] 12/23]. The European Crohn’s and Colitis Organisation [ECCO] produces and regularly updates several guidelines aimed at providing evidence-based guidance on critical aspects of IBD care to all health care professionals who manage patients with IBD. To provide high-quality evidence-based recommendations on medical treatment in CD, ECCO decided to develop these guidelines by adopting the GRADE [Grading of Recommendations Assessment, Development, and Evaluation] approach.9 GRADE is a systematic process for developing guidelines which addresses how to frame the health care questions, summarise the evidence, formulate the recommendations, and grade their strength and the quality of the associated evidence. GRADE increases transparency at all levels of this process and makes explicit the three considerations that lead to a particular recommendation: the quality of the evidence, the balance of benefits and harms, and the patients’ values and preferences. Therefore ECCO reviewed the available high-quality evidence on the medical management of CD and developed evidence-based recommendations on the medical treatment of adult patients with CD. These guidelines do not cover specific situations, such as postoperative management of adult patients with CD, which was already covered in the latest ECCO Guidelines on Crohn’s disease.10 Based on the GRADE workflow, the Guidelines Committee of ECCO [GuiCom] selected a panel of 48 experts supported by a team of methodologists and librarians. Selection was based on IBD expertise, scientific background, and knowledge of the GRADE methodology. All panellists received adequate training in GRADE before starting the process. Additionally, four patients with CD representing the European Federation of Crohn’s and Colitis Associations [EFCCA] were invited to participate in all face-to-face meetings and to provide their experiences and state their preferences. Three domains for medical treatment of CD were identified: 1] induction therapy; 2] maintenance therapy; 3] therapy of fistulising perianal disease. All panellists were assigned to one of three working groups coordinated by one to two working group leaders under the supervision of two Guideline coordinators. The panellists first formulated a series of specific questions using the PICO format [Population, Intervention, Comparator, Outcomes] which were deemed to be clinically important for the medical treatment of CD. The outcomes of all PICO questions were subsequently graded as ‘not important’, ‘important’, or ‘critical’ during a face-to-face kick-off meeting in Vienna, using a Delphi consensus process. A team of professional librarians performed a comprehensive literature search on EMBASE, PubMed/Medline, and Cochrane Central databases using specific search strings for each PICO question [Supplementary Files 1, 2, and 3, available as Supplementary data at ECCO-JCC online]. Two independent working group members [one assigned to the PICO and another one from the same group as a second reviewer] assessed the relevance of each abstract to PICO and included or excluded all the relevant papers for the final data extraction and analysis. Subsequently, the working group members assigned to each PICO question systematically reviewed and summarised the evidence on every outcome, to compile a Summary of Findings [SoF] table for each question. The GRADE method follows a hierarchical approach to synthesise evidence; recent high-quality systematic reviews and meta-analyses of clinical trials were preferentially used to create the recommendations. When these were not available, individual randomised clinical trials [RCTs] followed by observational studies were reviewed; results of individual studies were pooled using random-effects meta-analysis as appropriate and when needed. To define disease activity and severity [mild-to-moderate and moderate-to-severe], we accepted the definitions used by the investigators of the studies selected as an evidence basis for our work. The quality of evidence was c
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Strategies for treatment of PSC-IBD do not differ from IBD alone.
“Strategies for treatment of PSC-IBD do not differ from IBD alone.362,372,373”
From EASL Clinical Practice Guidelines on sclerosing cholangitis (2022) · cites this paper as [373]
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Self-citation
- Authors
- Torres, J., Bonovas, S., Doherty, G., Kucharzik, T., Gisbert, J. P., Raine, T., Adamina, M., Armuzzi, A., Bachmann, O., Bager, P., Biancone, L., Bokemeyer, B., Bossuyt, P., Burisch, J., Collins, P., El-Hussuna, A., Ellul, P., Frei-Lanter, C., Furfaro, F., Gingert, C., Gionchetti, P., Gomollon, F., González-Lorenzo, M., Gordon, H., Hlavaty, T., Juillerat, P., Katsanos, K., Kopylov, U., Krustins, E., Lytras, T., Maaser, C., Magro, F., Kenneth Marshall, J., Myrelid, P., Pellino, G., Rosa, I., Sabino, J., Savarino, E., Spinelli, A., Stassen, L., Uzzan, M., Vavricka, S., Verstockt, B., Warusavitarne, J., Zmora, O., & Fiorino, G.
- Affiliations
- Hospital Beatriz Ângelo (PT)
- Humanitas University (IT)
- University College Dublin (IE)
- Klinikum Lüneburg (DE)
- Hospital Universitario de La Princesa (ES)
- Cambridge University Hospitals NHS Foundation Trust (GB)
- University of Basel (CH)
- Agostino Gemelli University Polyclinic (IT)
- Siloah St. Trudpert Klinikum (DE)
- Aarhus University Hospital (DK)
- University of Rome Tor Vergata (IT)
- Gastroenterology Practice Minden, Minden, Germany
- Imelda Hospital (BE)
- University of Copenhagen (DK)
- Royal Liverpool University Hospital (GB)
- Department of Surgery, Aalborg University Hospital, Aalborg, Denmark
- Mater Dei Hospital (MT)
- Spital Zollikerberg (CH)
- IRCCS Humanitas Research Hospital (IT)
- Witten/Herdecke University (DE)
- University of Bologna (IT)
- IBD UNIT, Hospital Clíico Universitario ‘Lozano Blesa’; IIS Aragón, CIBEREHD, Zaragoza, Spain
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Barts Health NHS Trust (GB)
- Fifth Department of Internal Medicine, Comenius University Medical School, Bratislava, Slovakia
- University Hospital of Bern (CH)
- University of Ioannina (GR)
- Tel Aviv University (IL)
- Department of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Department of Internal medicine, Riga Stradiņš university, Riga, Latvia
- National Public Health Organization (GR)
- Universidade do Porto (PT)
- Department of Medicine [Division of Gastroenterology] and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
- Linköping University (SE)
- University of Campania "Luigi Vanvitelli" (IT)
- Department of Gastroenterology, IPOLFG, Lisbon, Portugal
- Department of Gastroenterology and Hepatology, University Hospitals, KU Leuven, Leuven, Belgium
- University of Padua (IT)
- Maastricht University Medical Centre (NL)
- Hôpital Beaujon (FR)
- University Hospital Zurich (CH)
- Universitair Ziekenhuis Leuven (BE)
- St Mark's Hospital (GB)
- Assaf Harofeh Medical Center (IL)
- Corresponding author
- Fiorino, Gionata
- ORCID
- Torres, Joana
- Bonovas, Stefanos
- Doherty, Glen
- Kucharzik, Torsten
- Gisbert, Javier P
- Raine, Tim
- Adamina, Michel
- Armuzzi, Alessandro
- Bachmann, Oliver
- Bager, Palle
- Biancone, Livia
- Bokemeyer, Bernd
- Bossuyt, Peter
- Burisch, Johan
- Collins, Paul
- Ellul, Pierre
- Furfaro, Federica
- Gionchetti, Paolo
- Gordon, Hannah
- Juillerat, Pascal
- Kopylov, Uri
- Lytras, Theodore
- Maaser, Christian
- Magro, Fernando
- Myrelid, Pär
- Pellino, Gianluca
- Rosa, Isadora
- Savarino, Edoardo
- Spinelli, Antonino
- Stassen, Laurents
- Uzzan, Mathieu
- Vavricka, Stephan
- Verstockt, Bram
- Warusavitarne, Janindra
- Zmora, Oded
- Fiorino, Gionata
- Venue
- Journal of Crohn's and Colitis
- Publisher
- Oxford University Press (OUP)
- Published
- 2019-11-11
- Volume
- 14
- Issue
- 1
- Pages
- 4-22
- ISSN
- 1873-9946 (ISSN-L)
- 1876-4479
- OpenAlex
- W4211167126
- Cited by
- 1,374
- References
- 155
- Citations by year
- 2026: 112 · 2025: 199 · 2024: 299 · 2023: 259 · 2022: 200 · 2021: 188 · 2020: 113 · 2013: 1
- FWCI
- 75.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Journal of Crohn s and Colitis (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- VBN Forskningsportal (Aalborg Universitet) (acceptedVersion, other-oa)
- Lirias (KU Leuven) (submittedVersion, other-oa)
- Padua Research Archive (University of Padova) (submittedVersion, other-oa)
- Zaguan (Universidad de Zaragoza) (submittedVersion)
- Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
- BORIS (University Library Bern) (submittedVersion, other-oa)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, other-oa)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Open Access CRIS of the University of Bern
- Funders
- European Crohn’s and Colitis Organisation
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
- Keywords
- Crohn's disease, medical therapy
- MeSH terms
- Adrenal Cortex Hormones, Anti-Inflammatory Agents, Anti-Bacterial Agents, Antibodies, Monoclonal, Crohn Disease, Drug Therapy, Combination, Humans, Immunosuppressive Agents, Rectal Fistula, Severity of Illness Index, Maintenance Chemotherapy, Induction Chemotherapy
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