Outcomes of Anti-TNF Treatment in Crohn’s Disease: A Real-Life, Tertiary Center Experience (original) (raw)
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The American …, 2002
OBJECTIVES: Infliximab, a chimeric monoclonal antibody directed against tumor necrosis factor-␣ (anti-TNF-␣), has been effective in the treatment of patients with active Crohn's disease and with fistulas. We investigated the effect of infliximab on circulating cytokines and acute phase proteins in patients with fistulas to determine the clinical response to anti-TNF-␣. METHODS: A total of 36 patients with fistulizing Crohn's disease were selected for study. Serum from patients was drawn before the infusion on day 0 and at wk 2, 4, 6, 8, and 10 after completion of treatment. Circulating concentrations of TNF-␣, interleukin-1 (IL-1), and IL-6 were measured by ELISA. The functional activity of circulating TNF-␣ was assessed by the WEHI 164 TNF-␣ bioassay. Acute phase proteins were also determined. RESULTS: Elevated TNF-␣, IL-1, IL-6, and acute phase proteins were observed in patients with Crohn's disease. Of the patients with fistulas, 22 (61.1%) responded to treatment. Before receiving infliximab, higher levels of serum TNF-␣ were found in patients who did not respond to infliximab compared with those who did (median interquartile range 26, 0-245 pg/ml; n ϭ 14 vs 0, 0-22 pg/ml, n ϭ 22). Patients showed no change in circulating levels of TNF-␣ during the course of the study. CONCLUSIONS: This treatment produces a clinical improvement in about two-thirds of CD patients with fistulas. The circulating levels of TNF-␣ are associated with the response to infliximab and could help to identify patients who would benefit from anti-TNF-␣ treatment.
Inflammatory Bowel Diseases, 2012
Background: Symptom relief is the traditional treatment goal in Crohn's disease (CD). New goals including mucosal healing and bowel preservation are now achievable with tumor necrosis factor (TNF) antagonists. Infliximab and adalimumab are approved as second-line treatments for severe, active CD. Certolizumab pegol is approved only in the U.S. and Switzerland as second-line treatment for moderate-to-severe, active CD. Data from trials of infliximab suggest that high-risk patients and patients with active inflammation (CRP elevation and/or ileocolonic ulcers) may benefit from earlier use of this drug.
Canadian Journal of Gastroenterology, 2009
BACKGROUND: Guidelines regarding the use of infliximab in Crohn’s disease were previously published by the Canadian Association of Gastroenterology in 2004. However, recent clinical findings and drug developments warrant a review and update of these guidelines.OBJECTIVE: To review and update Canadian guidelines regarding the use of tumour necrosis factor-alpha antibody therapy in both luminal and fistulizing Crohn’s disease.METHODS: A consensus group of 25 voting participants developed a series of recommendation statements that addressed pertinent clinical questions and gaps in existing knowledge. An iterative voting and feedback process was used in advance of the consensus meeting in conjunction with a systematic literature review to refine the voting statements. These statements were brought to a formal consensus meeting held in Montreal, Quebec (March 2008), wherein each statement underwent discussion, reformulation, voting and subsequent revision until group consensus was obtain...
Do not assume symptoms indicate failure of anti-tumor necrosis factor therapy in Crohn's disease
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2011
It is a challenge to monitor patients with Crohn's disease who remain symptomatic despite anti-tumor necrosis factor therapy. Clinicians must use a systematic approach for each patient and obtain objective evidence about disease activity and response to therapy. Alternate etiologies for symptoms should be sought and treated, if found. Active Crohn's disease despite therapy requires reassessment and adjustments to management plans.
Scientific Reports, 2021
Crohn’s disease (CD) is often complicated by strictures and associated with increased risk for surgery. Inflammatory strictures respond to medical therapy, and anti-tumor necrosis factor (TNF) therapy is often used after the failure of steroids. However, data on efficacy of anti-TNF therapy in stricturing CD is limited. We retrospectively analysed the records of patients with stricturing CD who were treated with anti-TNF therapy and were prospectively followed from January 2005 to July 2020. Treatment success was defined as continuation of anti-TNF without the requirement for steroids or parenteral nutrition, switch to other anti-TNF, endoscopic dilation, surgery and severe adverse events leading to the withdrawal of anti-TNF. Fifty-nine patients were included [50-infliximab, 9-adalimumab; mean age-30.1 ± 15 years; males-69.5%; median disease duration-124 (range 30–396) months; median follow-up duration-42 (range 8–180) months]. Ileum was the most common site of stricture (69.5%), 2...
Digestive and Liver Disease, 2016
Background: Soluble tumour necrosis factor-␣ (sTNF-␣) has been reported to increase in the course of anti-TNF-␣ therapy for rheumatoid and skin diseases. Aims: To assess changes in sTNF-␣ and clinical efficacy of anti-TNF-␣ agents in Crohn's disease (CD). Methods: Sixty-four patients on infliximab or adalimumab were analyzed. Clinical outcomes were assessed by using CD Activity Index after the induction therapy and at week 52. sTNF-␣ was measured before and after the induction therapy with high-sensitivity immunoassay. Results: In the majority of patients, sTNF-␣ increased significantly. Those with the greatest increase were more likely to experience long-term response, were more often treated with infliximab, had less frequently isolated small bowel CD, and tended to have sTNF-␣ levels at baseline that correlated with C-reactive protein. Conclusions: Neutralization of sTNF-␣ does not seem to be critical for the efficacy of anti-TNF-␣ therapy in CD. Paradoxically-an increase in sTNF-␣ may reflect an ongoing process that is beneficial for the clinical outcome.
Safety of anti-tumor necrosis factor therapy in inflammatory bowel disease
World Journal of Gastroenterology, 2009
Inflammatory bowel disease (IBD), in particular Crohn's disease refractory to conventional therapy, fistulizing Crohn's disease and chronic active ulcerative colitis, generally respond well to anti-tumor necrosis factor (TNF) therapy. However, serious side effects do occur, necessitating careful monitoring of therapy. Potential side effects of anti-TNF therapy include opportunistic infections, which show a higher incidence when concomitant immunosuppression is used. Furthermore, antibody formation against anti-TNF is associated with decreased efficacy and an increased frequency of infusion reactions. The hypothesis of a slightly increased risk of lymphomas in IBD patients treated with anti TNF-therapy is debatable, since most studies lack the specific design to properly address this issue. Alarmingly, the occurrence of hepatosplenic T-cell lymphomas coincides with combined immunosuppressive therapy. Despite the potential serious side effects, anti-TNF therapy is an effective and relatively safe treatment option for refractory IBD. Future research is needed to answer important questions, such as the long-term risk of malignancies, safety during pregnancy, when to discontinue and when to switch anti-TNF therapy, as well as to determine the balance between therapeutic and toxic effects.