Review Article: Infliximab for Crohn's disease treatment: shifting therapeutic strategies after 10 years of clinical experience
Résumé
Background: Crohn's disease (CD) is a progressive condition, with most patients developing a penetrating or stricturing complication over time. A decade ago, treatment goals consisted of immediate symptomatic control. The introduction of anti-TNF therapies, however, has changed the way patients with CD are treated. Over 10 years of clinical data and experience have demonstrated these therapies to be highly effective in CD. Aim: To provide clinicians guidance on optimising treatment with anti-TNF therapies in CD by introducing an evidence- and personal opinion based treatment algorithm using infliximab initial anti-TNF therapy. Methods: Scientific literature was reviewed using MEDLINE to evaluate data on clinical trials with infliximab in luminal and fistulising CD. Results: The data from several landmark infliximab trials have changed clinical practice and led to a readjustment of treatment goals in CD, allowing patients to achieve more than just symptomatic relief including sustained steroid-free remission. Infliximab induces complete mucosal healing and reduces the rates of hospitalisation and surgery. Based on disease-related risk factors, a treatment algorithm for infliximab is delineated in favour of a rapid step-up approach in patients at high risk for a disabling course of disease. Conclusions: Adopting the suggested treatment algorithm for infliximab into clinical routine is aimed to optimise outcomes for patients with CD.
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