Recommendations for the treatment of Crohn's disease with tumor necrosis factor antagonists: an expert consensus report.
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.


METHODS
A Delphi survey was used to obtain consensus on issues surrounding bowel preservation and use of TNF antagonists. At the time of this survey, infliximab was the only TNF antagonist approved for the treatment of CD in Europe, Canada, and Australia. An expert panel of 12 gastroenterologists with substantial clinical experience using infliximab in clinical practice and trials in these areas participated.


RESULTS
The experts agreed that bowel preservation and mucosal healing are relevant and achievable goals, and form a rationale for using TNF antagonists in CD patients. Control of inflammation and induction of mucosal healing were considered essential for bowel preservation. Consensus areas: 1) mucosal healing is predictive of improved long-term disease course and increases the likelihood of steroid-free remission; 2) infliximab induces sustained mucosal healing, promotes bowel preservation, and reduces hospitalizations and surgeries; 3) benefits of infliximab in relation to mucosal healing, bowel preservation, and clinical remission increase when therapy is initiated earlier.


CONCLUSIONS
Treatment with TNF antagonists helps preserve the bowel in CD patients.
Robarts Research Institute, University of Western Ontario, London, Canada. bfeagan@robarts.ca
Brian G
BG
Feagan
Marc
M
Lémann
Ragnar
R
Befrits
William
W
Connell
Geert
G
D'Haens
Subrata
S
Ghosh
Pierre
P
Michetti
Thomas
T
Ochsenkühn
Remo
R
Panaccione
Stefan
S
Schreiber
Mark
M
Silverberg
Dario
D
Sorrentino
C Janneke
CJ
van der Woude
Severine
S
Vermeire
Paul
P
Rutgeerts
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D032921:Consensus; D003424:Crohn Disease / Q000188:drug therapy*; D017408:Guidelines as Topic; D006801:Humans; D000069285:Infliximab; D058028:Research Report; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab