title: Maintenance treatment with infliximab for the management of Crohn's disease in adults.
abstract: Crohn's disease (CD) is a chronic, relapsing disease, the continuous cycle of which deeply affects the long-term course which, eventually, leads to fibrosis and development of transmural complications. It is well known that CD is an immune-mediated clinical condition and that tumor necrosis factor-alpha (TNF-alpha) plays a fundamental role in the pathogenesis of the disease. Current clinical guidelines recommend that patients with mild to moderate active CD should be treated initially with corticosteroids. Although this approach is effective in inducing remission, some patients may become dependent on, or refractory to, these drugs in the long term, thus increasing the risk of developing steroid-related adverse effects. A recent Cochrane systematic review established that infliximab (IFX) is effective in inducing remission in patients with CD. Although only a few published studies have assessed IFX for the maintenance of remission in the long term, there is evidence that IFX is superior to placebo in sustaining clinical remission and fistula healing; moreover, corticosteroid-sparing effects have been demonstrated. IFX is associated with the formation of antibodies to IFX which can lead to infusion reactions and shorter duration of response, but when comparing episodic vs scheduled maintenance treatment, the latter appears to sensibly reduce immunogenicity, thus offering improved efficacy and tolerance. The final point to consider is the best time to introduce IFX in the therapeutic algorithm of CD. Early use of IFX has been suggested to be more effective than late, and may potentially change the natural history of the disease. Effective induction and maintenance therapy with IFX is the only means with which to maintain long-lasting clinical and mucosal remission which, in turn, may modify the long-term course of the disease. Furthermore, when treating inflammatory bowel disease patients with IFX, an appropriate risk-benefit balance has to be taken into consideration, because the precise risk of serious adverse events associated with anti-TNF treatment in CD remains to be fully elucidated.
authors.affiliation: Department of Digestive Diseases, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Caviglia
authors.forename: Ivo
authors.initials: I
authors.lastname: Boskoski
authors.forename: Michele
authors.initials: M
authors.lastname: Cicala
references.citation: Gastroenterology. 2007 Mar;132(3):863-73; quiz 1165-6
references.pmid: 17324398
references.citation: Gastroenterology. 2006 Mar;130(3):940-87
references.pmid: 16530532
references.citation: Expert Opin Drug Saf. 2008 Sep;7(5):617-32
references.pmid: 18759714
references.citation: Cell. 2007 Oct 5;131(1):33-45
references.pmid: 17923086
references.citation: World J Gastroenterol. 2007 Oct 21;13(39):5238-44
references.pmid: 17876895
references.citation: Clin Gastroenterol Hepatol. 2006 Oct;4(10):1248-54
references.pmid: 16931170
references.citation: Gastroenterology. 2001 Aug;121(2):255-60
references.pmid: 11487534
references.citation: Aliment Pharmacol Ther. 2000 Dec;14(12):1553-9
references.pmid: 11121902
references.citation: Rev Gastroenterol Disord. 2004;4 Suppl 3:S18-24
references.pmid: 15580149
references.citation: Gastroenterology. 2008 Jun;134(7):1861-8
references.pmid: 18440315
references.citation: Aliment Pharmacol Ther. 2004 May 1;19(9):1019-24
references.pmid: 15113369
references.citation: Gastroenterol Clin North Am. 2002 Mar;31(1):1-20
references.pmid: 12122726
references.citation: Aliment Pharmacol Ther. 2002 Jan;16(1):51-60
references.pmid: 11856078
references.citation: N Engl J Med. 2004 Feb 26;350(9):876-85
references.pmid: 14985485
references.citation: Gut. 2007 Sep;56(9):1226-31
references.pmid: 17229796
references.citation: Mol Immunol. 2005 May;42(8):887-93
references.pmid: 15829278
references.citation: Clin Gastroenterol Hepatol. 2004 Jul;2(7):542-53
references.pmid: 15224278
references.citation: Cytokine. 1995 Apr;7(3):251-9
references.pmid: 7640345
references.citation: N Engl J Med. 2003 Feb 13;348(7):601-8
references.pmid: 12584368
references.citation: J Immunol. 2006 Feb 15;176(4):2617-24
references.pmid: 16456024
references.citation: Biomed Pharmacother. 2007 Jan;61(1):75-80
references.pmid: 17184965
references.citation: Am J Gastroenterol. 2006 May;101(5):1030-8
references.pmid: 16606351
references.citation: Gastrointest Endosc. 2006 Mar;63(3):433-42; quiz 464
references.pmid: 16500392
references.citation: Arthritis Rheum. 2006 Mar;54(3):702-10
references.pmid: 16508926
references.citation: Cochrane Database Syst Rev. 2004;(1):CD003574
references.pmid: 14974022
references.citation: Gastroenterology. 2010 Feb;138(2):463-8; quiz e10-1
references.pmid: 19818785
references.citation: Gastroenterology. 2006 Mar;130(3):650-6
references.pmid: 16530505
references.citation: Lancet. 2002 May 4;359(9317):1541-9
references.pmid: 12047962
references.citation: Dig Liver Dis. 2008 Jul;40 Suppl 2:S225-8
references.pmid: 18598993
references.citation: N Engl J Med. 1997 Oct 9;337(15):1029-35
references.pmid: 9321530
references.citation: Arthritis Rheum. 2006 Jan;54(1):26-37
references.pmid: 16385520
references.citation: Lancet. 2008 Jul 5;372(9632):67-81
references.pmid: 18603161
references.citation: Gastroenterology. 2003 Apr;124(4):917-24
references.pmid: 12671888
references.citation: Gastroenterology. 2006 Apr;130(4):1054-61
references.pmid: 16618399
references.citation: Gut. 2005 Feb;54(2):237-41
references.pmid: 15647188
references.citation: Lancet. 2008 Feb 23;371(9613):660-667
references.pmid: 18295023
references.citation: Gastroenterology. 2004 Feb;126(2):402-13
references.pmid: 14762776
references.citation: Arthritis Rheum. 2005 Nov;52(11):3381-90
references.pmid: 16258899
references.citation: Clin Gastroenterol Hepatol. 2008 Jun;6(6):644-53
references.pmid: 18550004
references.citation: Aliment Pharmacol Ther. 2005 Dec;22(11-12):1107-13
references.pmid: 16305724
references.citation: Gastroenterology. 1998 Jul;115(1):182-205
references.pmid: 9649475
references.citation: Inflamm Bowel Dis. 2007 Jun;13(6):769-96
references.pmid: 17304581
references.citation: N Engl J Med. 2008 Jan 31;358(5):528-30
references.pmid: 18234759
references.citation: Gastroenterology. 1999 Oct;117(4):761-9
references.pmid: 10500056