In a patient with Crohn's disease, which drug is best to initiate treatment?

In the context of initiating treatment for a patient with Crohn's disease, the most effective option is delayed-release budesonide. This medication is a corticosteroid specifically designed for the treatment of inflammatory bowel diseases, including Crohn's disease, by providing localized anti-inflammatory effects in the intestines while minimizing systemic side effects compared to traditional corticosteroids.

Delayed-release budesonide works by being released in the ileum and colon, which is crucial for targeting the areas typically affected by Crohn's disease. The formulation allows for a targeted approach, ensuring that the medication acts directly where it is needed, reducing inflammation and promoting healing in the gastrointestinal tract.

While extended-release budesonide is also a corticosteroid, its release profile may not be as optimized for certain segments of the intestines as the delayed-release formulation. Mesalamine enemas are effective for proximal colonic disease or rectal involvement but may not address more extensive disease in the small intestine effectively. Ustekinumab, a biologic agent, is typically reserved for more severe cases after conventional therapies like corticosteroids have been utilized or when there is no response to other treatments.

Thus, delayed-release budesonide is the most appropriate choice for initiating treatment in a patient with Crohn's disease