An analysis of factors influencing short‐term and sustained response to infliximab treatment for Crohn's disease

Arnott, Ian; McNeill, Graeme; Satsangi, Jack

doi:10.1046/j.1365-2036.2003.01574.x

Cited by 177 publications

(117 citation statements)

References 31 publications

Supporting

Mentioning

104

Contrasting

Unclassified

Order By: Relevance

“…Early reports of anti-TNF therapy found that 22% of smokers vs. 74% of nonsmokers responded to episodic use of infl iximab ( 175 ), and a prospective study of 74 patients given a single dose of infl iximab found that at 4 weeks smokers were less likely to have a response (OR 0.22; 95% CI, 0.08-0.41) and a shorter duration of response than non-smokers ( 176 ). In a retrospective study, patients with CD who continued to smoke required new courses of steroids and in multivariate analysis, smoking status was the only predictive factor of drug tolerance ( 177 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

403

421

View full text Add to dashboard Cite

Recent data suggest that infl ammatory bowel disease (IBD) patients do not receive preventive services at the same rate as general medical patients. Patients with IBD often consider their gastroenterologist to be the primary provider of care. To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. Gastroenterologists need to explicitly inform the primary care provider of the unique needs of the IBD patient, especially those on immunomodulators and biologics or being considered for such therapy. In particular, documentation of up to date vaccinations are crucial as IBD patients are often treated with long-term immune-suppressive therapies and may be at increased risk for infections, many of which are preventable with vaccinations. Health maintenance issues addressed in this guideline include identifi cation, safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer as well as identifi cation of depression and anxiety and smoking cessation. To accomplish these health maintenance goals, coordination between the primary care provider, gastroenterology team and other specialists is necessary. of evidence, we entered data from the papers of highest evidence into the GRADE program (accessible at http://www.gradepro.org ). Th e recommendation statements from this guideline are shown in Table 1 . Summary statements, when listed, are designed to be descriptive in nature without associated evidence-based ratings. VACCINATIONSRecent data suggest that IBD patients do not receive preventive services at the same rate as general medical patients ( 2 ). Members of the gastroenterology team are oft en the only clinicians that a patient with IBD will see. As such, it is incumbent upon gastroenterologists to take a proactive role in the health care needs of their IBD patients ( 3-5 ). It is crucial to clarify with the patient the limits of the specialist's responsibilities and delegate routine health care issues to the primary care clinician. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents. Although it appears that both primary care clinicians and gastroenterologists are hesitant to take ownership of vaccinations ( 6-8 ), it is reasonable ( 9 ) that vaccination recommendations be the responsibility of the treating gastroenterologist, but the actual delivery/administration of these vaccines may be a shared responsibility ( 10-13 ). Communicating specifi c recommendations to the primary care team in a concise fashion are needed. Consider empowering the patient by giving written recommendations to bring to their primary care physician. Clinicians sharing an electronic medical record should use this platform to send recommendations to the referring clinician.Patients with IBD are oft en treated with long-term immunesuppressive therapies and may t...

show abstract

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

403

421

View full text Add to dashboard Cite

show abstract

“…Established predictors of relapse of disease activity in CD such as smoking and use of non-steroidal anti-inflammatory drugs (NSAID), 24 as well as the predictors of short-and long-term response to infliximab such as concomitant use of immunosuppressive therapy, age and location of disease were recorded. [25][26][27][28] The phenotype of the CD patients was described using the Vienna classification. 29 Age at diagnosis, disease duration, surgical history, time since previous treatment for a flare and the number of treatments for CD during the previous 12 months were recorded as well.…”

Section: Measurement Of Disease-related Characteristicsmentioning

confidence: 99%

The impact of major depressive disorder on the short‐ and long‐term outcome of Crohn's disease treatment with infliximab

Persoons

Vermeire

Demyttenaere

et al. 2005

Aliment Pharmacol Ther

214

161

View full text Add to dashboard Cite

Summary Background: Major depressive disorder is the most common psychiatric diagnosis in Crohn's disease. In other chronic diseases, evidence suggests that depression influences the course of the disease. Strong evidence of such a mediating role of major depressive disorder in Crohn's disease has never been found.Aim: To assess the relationship between major depressive disorder and outcome of treatment of luminal Crohn's disease with infliximab.Methods: In this prospective study, 100 consecutive unselected patients underwent assessment of psychosocial, demographical disease‐related biological and clinical parameters at baseline and at 4 weeks after infliximab. Major depressive disorder was diagnosed using the Patient Health Questionnaire. Subsequently, the patients were followed up clinically until the next flare or during 9 months.Results: The Crohn's disease responded in 75% of the patients, and remission was achieved in 60%. The presence of major depressive disorder at baseline predicted a lower remission rate (OR = 0.166, 95% CI = 0.049–0.567, P = 0.004). At follow‐up, 88% of the patients needed retreatment. At univariate regression analysis, major depressive disorder significantly decreased time to retreatment (P = 0.001). Multivariate Cox regression confirmed major depressive disorder as an independent determinant of active disease both at baseline and at re‐evaluation (hazard ratio = 2.271, 95% CI: 1.36–3.79, P = 0.002).Conclusion: Major depressive disorder is a risk factor for failure to achieve remission with infliximab and for earlier retreatment in patients with active luminal Crohn's disease. Assessment and management of major depressive disorder should be part of the clinical approach to patients with Crohn's disease.

show abstract

“…1 Administration of recombinant immunomodulatory cytokines or monoclonal antibodies to neutralize specific inflammatory mediators has been shown to be effective in various inflammatory disorders. 2,3 Although cytokine-based therapy may represent an attractive therapeutic option for patients unresponsive to traditional treatments, systemic administration of such molecules has several drawbacks: short bioactivity, systemic toxicity, and high cost. 1 Administration of genes coding for immunomodulatory cytokines, aimed at providing therapeutic levels of cytokines produced directly in patient's tissues, gave exciting results in several models of immune-mediated diseases.…”

Section: Introductionmentioning

confidence: 99%

Engineered E. coli delivers therapeutic genes to the colonic mucosa

et al. 2005

View full text Add to dashboard Cite

Taking advantage of the proximity of bowel mucosa to luminal bacteria, we have attempetd to deliver a therapeutic gene to the colonic mucosa by oral administration of an invasive and non-pathogenic Escherichia coli. E. coli diamenopimelate (dap) auxotroph, harboring plasmid pGB2Oinv-hly, express the inv gene from Yersinia pseudotubercolosis that confers the ability to invade nonprofessional phagocytic cells and the hly gene from Listeria monocytogenes that allows expression of lystreriolysin O, a perforin cytolysin able to perfore phagosomal membranes. This bacterial vector invades and transfers functional DNA to epithelial cells in vitro. We have shown that this strain carrying a therapeutic gene (pC1OTGF-b1) can significantly reduce the severity of experimental colitis in mice. However, as a consequence of mucosal barrier disruption during colitis, vector-specific mRNA transcripts could be recovered from the colon and also from extra-colonic tissues. We therefore replaced the constitutive CMV promoter in pC1OTGF-b1 by the inflammation-inducible interleukin-8 promoter generating plasmid pC1OTGF-b1 IND . Plasmid-specific TGF-b1 mRNA transcripts were detectable in mouse CMT-93 epithelial cells incubated with E. coli BM2710/pGB2Oinv-hly carrying pC1OTGF-b1 IND following exposure to inflammatory cytokines. Furthermore, the transcripts were detectable only within inflamed tissues and the therapeutic effects were comparable to those in animals treated with E. coli BM2710/ pGB2Oinv-hly+pC1OTGF-b1. In summary, engineered enteric bacteria can efficiently deliver in vivo therapeutic genes to the intact intestinal mucosa and regulation expression of the therapeutic gene by an inflammation-inducible promoter prevents its dissemination during colitis.

show abstract

An analysis of factors influencing short‐term and sustained response to infliximab treatment for Crohn's disease

Cited by 177 publications

References 31 publications

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

The impact of major depressive disorder on the short‐ and long‐term outcome of Crohn's disease treatment with infliximab

Engineered E. coli delivers therapeutic genes to the colonic mucosa

Contact Info

Product

Resources

About