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Summary Background  Infliximab (IFX) could change the course of Crohn’s disease (CD) by reducing steroid use, surgery or prompting earlier introduction of immunomodulators (IMM). Aim  To evaluate the impact of IFX availability on the course of early CD. Methods  Two cohorts of newly diagnosed CD patients were identified: The first cohort included patients diagnosed from January 1994 to December 1997 and the second from January 2000 to December 2003. All patients were diagnosed, treated and followed up in the same centre until December 1999 (first cohort) or December 2005 (second cohort). Development of disease‐related complications, steroid, IMM or IFX requirements and intestinal resections during follow‐up were registered. Results  A total of 328 patients were included (146 first cohort, 182 second cohort). A similar proportion of patients in both cohorts received steroids, but steroid exposure resulted significantly more intense in the first cohort (P = 0.001). In the second cohort, 14% of patients received IFX. Thiopurines were used more (P = 0.001) and earlier (P = 0.012) in the second cohort. No differences in surgical requirements or the development of disease‐related complications were found. Conclusions  Following a step‐up therapeutic algorithm, IFX availability did not reduce surgical requirements or the development of disease‐related complications. Aliment Pharmacol Ther 31, 233–239

La colitis ulcerosa representa una de las dos principales entidades de la enfermedad inflamatoria intestinal; de causa desconocida, condicionada por un mecanismo etiopatogénico mediado por el sistema inmunitario innato y adaptativo, donde intervienen citocinas proinflamatorias conocidas como interleucinas (IL); el mecanismo mediado por el grupo de las IL-12 e IL-23 tiene un efecto proinflamatorio y estimulan el proceso de diferenciación de las células T mediante CD4+ en respuestas Th1 y Th17. El ustekinumab es un fármaco que suprime el efecto funcional de la actividad de la IL-12 e IL-23, que ha demostrado ser eficaz para inhibir la respuesta inflamatoria excesiva en la mucosa gastrointestinal. Reportado en los resultados en los estudios UNIFI, que demuestran la respuesta clínica, remisión clínica, remisión libre de esteroides, mejoría histológica y un buen perfil de seguridad en el manejo de los pacientes con colitis ulcerosa de moderada a grave refractaria a terapia convencional y/o con uso previo de anti-factor de necrosis tumoral alfa.

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