Addressing current treatment challenges in Crohn's disease in real life: a physician's survey

Dig Liver Dis. 2014 Dec;46(12):1066-71. doi: 10.1016/j.dld.2014.08.001. Epub 2014 Aug 29.


Background: In recent years several trials have addressed treatment challenges in Crohn's disease. Clinical trials however, represent a very special situation.

Aims: To perform a cross-sectional survey among gastroenterologists on the current clinical real life therapeutic approach focussing on the use of biologics.

Methods: A survey including six main questions on clinical management of loss of response, diagnostic evaluation prior to major treatment changes, preference for anti-tumour necrosis factor (TNF) agent, (de-)escalation strategies as well as a basic section regarding personal information was sent by mail to all gastroenterologists in Switzerland (n=318).

Results: In total, 120 questionnaires were analysed (response rate 37.7%). 90% of gastroenterologists in Switzerland use a thiopurine as the first step-up strategy (anti-TNF alone 7.5%, combination 2.5%). To address loss of response, most physicians prefer shortening the interval of anti-TNF administration followed by dose increase, switching the biologic and adding a thiopurine. In case of prolonged remission on combination therapy, the thiopurine is stopped first (52.6%) after a mean treatment duration of 15.7 months (biologic first in 41.4%).

Conclusions: Everyday clinical practice in Crohn's disease patients appears to be incongruent with clinical data derived from major trials. Studies investigating reasons underlying these discrepancies are of need to optimize and harmonize treatment.

Keywords: Anti-TNF agent; Crohn's disease; Loss of response; Step-up strategy; Thiopurine; Treatment de-escalation.

MeSH terms

  • Adult
  • Aged
  • Anti-Inflammatory Agents / therapeutic use*
  • Antibodies, Monoclonal / therapeutic use*
  • Crohn Disease / diagnosis
  • Crohn Disease / drug therapy*
  • Cross-Sectional Studies
  • Female
  • Gastroenterology
  • Health Care Surveys
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Induction Chemotherapy / methods*
  • Maintenance Chemotherapy / methods*
  • Male
  • Middle Aged
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Purines / therapeutic use
  • Surveys and Questionnaires
  • Switzerland
  • Thionucleosides / therapeutic use
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors


  • Anti-Inflammatory Agents
  • Antibodies, Monoclonal
  • Immunosuppressive Agents
  • Purines
  • Thionucleosides
  • Tumor Necrosis Factor-alpha