CROHN’S DISEASE IN THE ERA OF ADVANCED THERAPIES: NEW TARGETS, SUSTAINED REMISSION AND DISEASE COURSE MODIFICATION

Abstract

The expansion of the pharmacological armamentarium in Crohn’s disease has shifted clinical debate from symptom relief towards the possibility of interfering with the natural history of the condition. This critical narrative review examines the extent to which targets introduced over the past two decades (tumour necrosis factor antagonists, leucocyte trafficking blockade, interleukin-12 and interleukin-23 inhibition, selective blockade of the interleukin-23 p19 subunit and, among small molecules, Janus kinase inhibition) support outcomes of durable remission and disease course modification in adults with moderate-to-severe luminal disease. Searches were carried out in 2026 across international biomedical databases, indexed Ibero-American literature, and regulatory and scientific society documents, prioritising phase 3 trials with endoscopic endpoints, head-to-head studies, long-term open-label extensions, long-term population-based cohorts and current guidelines. The analysis is organised along four axes: the redefinition of treatment targets; mechanistic differentiation between drug classes and its limits; the durability of remission and the weight of study design on that estimate; and available evidence on phenotypic progression, resection and reoperation. Advanced therapies convincingly broadened clinical and endoscopic control, durability during treatment was demonstrated, and evidence of true structural modification remained more limited and heterogeneous, with early intervention and treatment strategy emerging as decisive factors.