Crohn\u27s Disease: Management, Emerging Therapies and the Role of the Pharmacist

Crohn\u27s disease is a relapsing-remitting disorder of the gastrointestinal tract caused by a mixture of genetic and environmental factors. Pharmacologic treatment of Crohn\u27s disease is patient-specific, and regimens vary widely between individuals. Drug regimens are typically based on 5-aminosalicylate therapy and may include a combination of steroids, histamine 2 receptor antagonists, proton pump inhibitors, immunomodulators, antibiotics, biologic agents and other medications aimed at symptom relief. A new medication, vedolizumab, is currently in phase III clinical trials awaiting U.S. Food and Drug Administration (FDA) approval for use in Crohn\u27s disease. Vedolizumab is an alpha-integrin inhibitor, which is anticipated to have a better safety profile than Tysabri® ( natalizumab ), an alpha-integrin inhibitor already approved for treatment of Crohn\u27s disease. Pharmacists have an opportunity to educate Crohn\u27s disease patients about nonpharmacologic management including counseling on diet, exercise, stress-relief therapy and use of multivitamins as well as the importance of regular colonoscopies and visits to a primary care practitioner. Pharmacists can also educate patients and practitioners about alternative therapies including probiotics, fecal microbiota transplantation and fish oils which may help manage the disease