Long-term safety of infliximab for the treatment of inflammatory bowel disease: a single-centre cohort study

Fidder, Herma H.; Schnitzler, Fabian; Ferrante, Marc; Noman, Maja; Katsanos, K.H.; Segaert, Siegfried; Henckaerts, Liesbet; Assche, Gert Van; Vermeire, Séverine; Rutgeerts, Paul

doi:10.1136/gut.2008.163642

Cited by 407 publications

(287 citation statements)

References 31 publications

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“…Table 1 depicts the safety data, benchmarked by other selected real-life cohorts. The American TREAT registry for patients with IBD did not identify anti-TNF therapy as an independent risk factor for the development of serious infections [11] whereas the Leuven experience highlighted concomitant steroid therapy as a risk factor [9]. Although the present study reported an increased malignancy rate, the authors rightly state that the increase could be also attributed to the underlying disease, other concomitant medications, and referral bias.…”

contrasting

confidence: 65%

“…1, benchmarked by some other long-term real-life reports, most notably the Leuven cohort, which reviewed the outcome of 614 patients [7] and the safety of 734 patients [9]. Direct comparison between the studies is challenging in view of the different follow-up periods and definitions of response as well as the variable inclusion of patients with episodic treatment and fistulizing disease.…”

mentioning

confidence: 99%

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Understanding Infliximab in Crohn’s Disease: The Long-Term Outcomes

Turner

Lev-Tzion

2012

Dig Dis Sci

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contrasting

confidence: 65%

mentioning

confidence: 99%

Understanding Infliximab in Crohn’s Disease: The Long-Term Outcomes

Turner

Lev-Tzion

2012

Dig Dis Sci

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“…Further confi rmation in large prospective analyses is important to validate these initial observations. Th ere have been several studies that have highlighted an elevated risk of NMSC in patients with IBD ( 134,(138)(139)(140)(141)(142)(143)(144)(145)(146). It is recognized that individuals who use antimetabolite therapy with either azathioprine or 6-mercpatopurie whether current or prior use-escalates the risk of NMSC for users.…”

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

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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...

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“…Even after extensive world-wide experience with anti-TNF-therapy in IBD and other indications, such as rheumatological or dermatological diseases, there still is some uncertainty about potential risks [9][10][11][12][13] . In the last few years, there has been an increasing trend towards an earlier introduction of TNF-inhibitors (which is associated with a better efficacy 14 ) either via a rapid step up 15,16 or top down 17 , to avoid prolonged steroid exposure and minimizing CDassociated morbidity and the need for surgery.…”

Section: Introductionmentioning

confidence: 99%

Addressing current treatment challenges in Crohn's disease in real life: A physician's survey

Vavricka

Radivojevic²,

Manser³

et al. 2014

Digestive and Liver Disease

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BACKGROUND: In recent years several trials have addressed treatment challenges in Crohn's disease. Clinical trials however, represent a very special situation. AIMS: To perform a cross-sectional survey among gastroenterologists on the current clinical real life therapeutic approach focussing on the use of biologics. METHODS: A survey including six main questions on clinical management of loss of response, diagnostic evaluation prior to major treatment changes, preference for anti-tumour necrosis factor (TNF) agent, (de-)escalation strategies as well as a basic section regarding personal information was sent by mail to all gastroenterologists in Switzerland (n=318). RESULTS: In total, 120 questionnaires were analysed (response rate 37.7%). 90% of gastroenterologists in Switzerland use a thiopurine as the first step-up strategy (anti-TNF alone 7.5%, combination 2.5%). To address loss of response, most physicians prefer shortening the interval of anti-TNF administration followed by dose increase, switching the biologic and adding a thiopurine. In case of prolonged remission on combination therapy, the thiopurine is stopped first (52.6%) after a mean treatment duration of 15.7 months (biologic first in 41.4%). CONCLUSIONS: Everyday clinical practice in Crohn's disease patients appears to be incongruent with clinical data derived from major trials. Studies investigating reasons underlying these discrepancies are of need to optimize and harmonize treatment.

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Long-term safety of infliximab for the treatment of inflammatory bowel disease: a single-centre cohort study

Abstract: Long-term infliximab treatment had a good overall safety profile in the patient cohort studied.

Cited by 407 publications

References 31 publications

Understanding Infliximab in Crohn’s Disease: The Long-Term Outcomes

Understanding Infliximab in Crohn’s Disease: The Long-Term Outcomes

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Addressing current treatment challenges in Crohn's disease in real life: A physician's survey

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