{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T14:33:42Z","timestamp":1790087622756,"version":"4.0.1"},"reference-count":26,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,28]],"date-time":"2025-09-28T00:00:00Z","timestamp":1759017600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["JCM"],"abstract":"<jats:p>The treatment algorithm for Crohn\u2019s disease evolves over time. In this review article we highlight nine studies from the last decade that have influenced our thinking on the treatment of Crohn\u2019s disease. This perspective is a narrative, opinion-based review and reflects our personal thinking on some aspects of the treatment of Crohn\u2019s disease. We selected original studies that have influenced our thoughts on luminal Crohn\u2019s disease treatment significantly. Moderate to severe Crohn\u2019s disease should be treated appropriately from diagnosis with advanced therapy or surgery in select cases of limited ileal disease. Close observation may be sufficient for mild cases. Small intra-abdominal abscesses can be treated without surgery in some cases and a cooperative multi-disciplinary team working approach with radiology, surgery and dietitians is key. Anti-TNF therapy provides effective and relatively inexpensive first-line treatment but requires careful therapeutic monitoring and\/or immunomodulator co-therapy to avoid immunogenicity. Those achieving remission at 1 year very often maintain this long-term. For those experiencing non-response or loss of response to anti-TNF therapy, ustekinumab or risankizumab offer appropriate second-line treatments. Biomarkers to better guide treatment decisions are urgently needed. Dietary approaches to the management of Crohn\u2019s disease are currently evolving and may provide a future disease-modifying avenue.<\/jats:p>","DOI":"10.3390\/jcm14196879","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T09:12:23Z","timestamp":1759223543000},"page":"6879","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Perspective: Making Treatment Decisions for Crohn\u2019s Disease in 2025\u2014Key Considerations"],"prefix":"10.3390","volume":"14","author":[{"given":"Mario Andrea","family":"Latorre","sequence":"first","affiliation":[{"name":"Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK"},{"name":"Department of Internal Medicine and Medical Therapeutics, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Rennie","sequence":"additional","affiliation":[{"name":"Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7260-1866","authenticated-orcid":false,"given":"Konstantina","family":"Rosiou","sequence":"additional","affiliation":[{"name":"Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2022-5859","authenticated-orcid":false,"given":"Christian Philipp","family":"Selinger","sequence":"additional","affiliation":[{"name":"Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"s1","DOI":"10.1136\/gutjnl-2019-318484","article-title":"British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults","volume":"68","author":"Lamb","year":"2019","journal-title":"Gut"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2769","DOI":"10.1016\/S0140-6736(17)32448-0","article-title":"Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: A systematic review of population-based studies","volume":"390","author":"Ng","year":"2017","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1016\/j.crohns.2013.01.010","article-title":"The burden of inflammatory bowel disease in Europe","volume":"7","author":"Burisch","year":"2013","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.1053\/j.gastro.2020.12.031","article-title":"STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organization for the Study of IBD (IOIBD): Determining Therapeutic Goals for Treat-to-Target strategies in IBD","volume":"160","author":"Turner","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1093\/ecco-jcc\/jjae091","article-title":"ECCO Guidelines on Therapeutics in Crohn\u2019s Disease: Medical Treatment","volume":"18","author":"Gordon","year":"2024","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"s1","DOI":"10.1136\/gutjnl-2024-334395","article-title":"British Society of Gastroenterology guidelines on inflammatory bowel disease in adults: 2025","volume":"74","author":"Moran","year":"2025","journal-title":"Gut"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.1053\/j.gastro.2021.09.078","article-title":"Breaking Through the Therapeutic Ceiling: What Will It Take?","volume":"162","author":"Raine","year":"2022","journal-title":"Gastroenterology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1093\/aje\/kwae260","article-title":"Introduction to network meta-analysis: Understanding what it is, how it is done, and how it can be used for decision-making","volume":"194","author":"Guyatt","year":"2025","journal-title":"Am. J. Epidemiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1136\/gutjnl-2022-328052","article-title":"Efficacy of biological therapies and small molecules in induction and maintenance of remission in luminal Crohn\u2019s disease: Systematic review and network meta-analysis","volume":"72","author":"Barberio","year":"2023","journal-title":"Gut"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2200","DOI":"10.1016\/S0140-6736(22)00688-2","article-title":"Ustekinumab versus adalimumab for induction and maintenance therapy in biologic-naive patients with moderately to severely active Crohn\u2019s disease: A multicentre, randomised, double-blind, parallel-group, phase 3b trial","volume":"399","author":"Sands","year":"2022","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.dld.2016.11.002","article-title":"Adalimumab dose escalation is effective and well tolerated in Crohn\u2019s disease patients with secondary loss of response to adalimumab","volume":"49","author":"Duveau","year":"2017","journal-title":"Dig. Liver Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/S2468-1253(24)00044-X","article-title":"Mechanisms and management of loss of response to anti-TNF therapy for patients with Crohn\u2019s disease: 3-year data from the prospective, multicentre PANTS cohort study","volume":"9","author":"Chanchlani","year":"2024","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1056\/NEJMoa2314585","article-title":"Risankizumab versus Ustekinumab for Moderate-to-Severe Crohn\u2019s Disease","volume":"391","author":"Chapman","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"ii54","DOI":"10.1093\/ecco-jcc\/jjac007","article-title":"IL-23 Blockade in Anti-TNF Refractory IBD: From Mechanisms to Clinical Reality","volume":"16","author":"Atreya","year":"2022","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"17562848241299737","DOI":"10.1177\/17562848241299737","article-title":"Appropriateness of small molecule agents for patients with IBD of childbearing age\u2014A RAND\/UCLA appropriateness panel","volume":"17","author":"Selinger","year":"2024","journal-title":"Ther. Adv. Gastroenterol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1097\/MOG.0000000000000943","article-title":"Managing the older adult with inflammatory bowel disease: Is age just a number?","volume":"39","author":"Bermudez","year":"2023","journal-title":"Curr. Opin. Gastroenterol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Fons, A., Kalisvaart, K., and Maljaars, J. (2023). Frailty and Inflammatory Bowel Disease: A Scoping Review of Current Evidence. J. Clin. Med., 12.","DOI":"10.3390\/jcm12020533"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1007\/s11894-024-00945-5","article-title":"Frailty: An Underappreciated Risk Factor for IBD Complications","volume":"26","author":"Venkatesh","year":"2024","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e44","DOI":"10.1136\/flgastro-2022-102187","article-title":"Managing IBD in patients with previous cancers","volume":"13","author":"Aiken","year":"2022","journal-title":"Frontline Gastroenterol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/S2468-1253(24)00034-7","article-title":"A biomarker-stratified comparison of top-down versus accelerated step-up treatment strategies for patients with newly diagnosed Crohn\u2019s disease (PROFILE): A multicentre, open-label randomised controlled trial","volume":"9","author":"Noor","year":"2024","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/S2468-1253(17)30248-0","article-title":"Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn\u2019s disease: A randomised controlled, open-label, multicentre trial","volume":"2","author":"Ponsioen","year":"2017","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1016\/S2468-1253(20)30117-5","article-title":"Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn\u2019s disease: Retrospective long-term follow-up of the LIR!C trial","volume":"5","author":"Stevens","year":"2020","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3365","DOI":"10.1016\/j.cgh.2023.01.013","article-title":"Adalimumab in Biologic-naive Patients With Crohn\u2019s Disease After Resolution of an Intra-abdominal Abscess: A Prospective Study From the GETAID","volume":"21","author":"Bouhnik","year":"2023","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1093\/ecco-jcc\/jjaa173","article-title":"Disease Activity Patterns of Crohn\u2019s Disease in the First Ten Years After Diagnosis in the Population-based IBD South Limburg Cohort","volume":"15","author":"Wintjens","year":"2021","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"i262","DOI":"10.1093\/ecco-jcc\/jjae190.0136","article-title":"DOP097 Emulsifier restriction is an effective therapy for active Crohn\u2019s disease: The ADDapt trial\u2014A multi-centre, randomised, double-blind, placebo-controlled, re-supplementation trial in 154 patients","volume":"19","author":"Bancil","year":"2025","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Svolos, V., Gordon, H., Lomer, M.C.E., Aloi, M., Bancil, A., Day, A.S., Day, A.S., Fitzpatrick, J.A., Gerasimidis, K., and Gkikas, K. (2025). ECCO Consensus on Dietary Management of Inflammatory Bowel Disease. J. 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