A key aim in the management of Crohn's disease is to maintain disease remission, whether this has been achieved by medical or surgical treatment. The reasons for doing this are to maintain quality of life, to avoid steroid dependence and to maintain mucosal healing with a view to preventing relapse, hospital admission and surgery, and improving disease natural history. Options for remission maintenance include smoking cessation, thiopurines, methotrexate, anti-TNF-α drugs and surgery. Evidence suggests that in some places now, and in most places in the past, too few patients are/were appropriately treated when in remission, and, in many instances, treatment regimens are/were insufficiently tailored to the patient's individual phenotype, prognosis and/or genotype.

Keywords:
Adalimumab, Anti-TNF therapy, Crohn’s disease, Infliximab, Maintenance therapy, Thiopurines
1.
Cosnes J, Beaugerie L, Carbonnel F, Gendre JP: Smoking cessation and the course of Crohn's disease: an intervention study. Gastroenterology 2001;120:1093-1099.
2.
Prefontaine E, Sutherland LR, MacDonald JK, et al: Azathioprine or 6-mercaptopurine for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev 2009;1: CD000067.
3.
Patel V, Macdonald JK, McDonald JW, Chande N: Methotrexate for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev 2009;7:CD006884.
4.
Behm BW, Bickston SJ: Tumor necrosis factor-alpha antibody for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev 2009;1:CD006893.
5.
Ramadas AV, Gunesh S, Thomas GA, Williams GT, Hawthorne AB: Natural history of Crohn's disease in a population-based cohort from Cardiff (1986-2003): a study of changes in medical treatment and surgical resection rates. Gut 2010;59:1200-1206.
6.
Laharie D, Reffet A, Belleannée G, Chabrun E, Subtil C, Razaire S, Capdepont M, de Lédinghen V: Mucosal healing with methotrexate in Crohn's disease: a prospective comparative study with azathioprine and infliximab. Aliment Pharmacol Ther 2011;33:714-721.
7.
Ezri J, Marques-Vidal P, Nydegger A: Impact of disease and treatments on growth and puberty of pediatric patients with inflammatory bowel disease. Digestion 2012;85:308-319.
8.
Lichtenstein GR, Sands BE, Pazianas M: Prevention and treatment of osteoporosis in inflammatory bowel disease. Inflamm Bowel Dis 2006;12:797-813.
9.
Gasche C, Berstad A, Befrits R, Beglinger C, Dignass A, Erichsen K, Gomollon F, Hjortswang H, Koutroubakis I, Kulnigg S, Oldenburg B, Rampton D, Schroeder O, Stein J, Travis S, Van Assche G: Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases. Inflamm Bowel Dis 2007;13:1545-1553.
10.
Benchimol EI, Cook SF, Erichsen R, Long MD, Bernstein CN, Wong J, Carroll CF, Frøslev T, Sampson T, Kappelman MD: International variation in medication prescription rates among elderly patients with inflammatory bowel disease. J Crohns Colitis 2013;7:878-889.
11.
Dignass A, Van Assche G, Lindsay JO, et al: The second European evidence-based consensus on the diagnosis and management of Crohn's disease: current management. J Crohns Colitis 2010;4:28-62.
12.
Beaugerie L, Seksik P, Nion-Larmurier I, Gendre JP, Cosnes J: Predictors of Crohn's disease. Gastroenterology 2006;130:650-656.
13.
Loly C, Belaiche J, Louis E: Predictors of severe Crohn's disease. Scand J Gastroenterol 2008;43:948-954.
14.
Treton X, Bouhnik Y, Mary JY, et al: Azathioprine withdrawal in patients with Crohn's disease maintained on prolonged remission: a high risk of relapse. Clin Gastroenterol Hepatol 2009;7:80-85.
15.
Teml A, Schaeffeler E, Herrlinger KR, Klotz U, Schwab M: Thiopurine treatment in inflammatory bowel disease: clinical pharmacology and implication of pharmacogenetically guided dosing. Clin Pharmacokinet 2007;46:187-208.
16.
Lee JC, Lyons PA, McKinney EF, Sowerby JM, Carr EJ, Bredin F, Rickman HM, Ratlamwala H, Hatton A, Rayner TF, Parkes M, Smith KG: Gene expression profiling of CD8+ T cells predicts prognosis in patients with Crohn disease and ulcerative colitis. J Clin Invest 2011;121:4170-4179.
17.
Rahier JF: Prevention and management of infectious complications in IBD. Dig Dis 2012;30:408-414.
18.
Bonaz BL, Bernstein CN: Brain-gut interactions in inflammatory bowel disease. Gastroenterology 2013;144:36-49.
19.
van Langenberg DR, Gibson PR: Systematic review: fatigue in inflammatory bowel disease. Aliment Pharmacol Ther 2010;32:131-143.
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2014
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