Practical application of anti-TNF therapy for luminal Crohnʼs disease

Abstract

Anti-tumor necrosis factor (TNF) therapy to treat inflammatory bowel disease has been available for more than a decade. Although extensive data on the outcome of anti-TNF therapy from individual clinical trials and patient cohorts are available, integrated guidance on the best use of such therapy to achieve optimal clinical outcomes when managing patients with luminal Crohn's disease is lacking. This review combines published data to establish practical strategies for anti-TNF therapy with respect to effective and safe timing of introduction, use of concurrent immunosuppressive therapy, dose escalation, managing relapse, changing drugs, pregnancy and breast feeding, and stopping drug treatment.

Long-Term Outcome of Patients With Crohn’s Disease Who Discontinued Infliximab Therapy Upon Clinical Remission

“…[7][8][9][10][11][12][13][14] Based on this available information, it is now generally recommended not to stop anti-TNF therapy in IBD patients achieving clinical remission. 15,20,21 However, in a real-life clinical setting, it is highly unlikely that IFX can be continued throughout the life span of all IBD patients who have obtained clinical remission.…”

“…[8][9][10][11][12][13][14] As a result, the decision of discontinuation is typically made on the basis of an individual judgement of benefits versus risks and cost-effectiveness. 15 The main goal of our study was to investigate the long-term outcome of CD patients who discontinued IFX due to clinical remission and to search for predictive factors of prolonged SCR after IFX cessation.…”

Predictors of relapse in patients with Crohn's disease in remission after 1 year of biological therapy

“…Kamm et al . proposed that biological therapy should not be stopped in high‐risk patients (those who have undergone multiple previous operations, demonstrated intolerance to multiple drugs or in whom the disease is difficult to control). Moreover, subgroups of patients may remain in longstanding clinical remission.…”

Individualised therapy is more cost-effective than dose intensification in patients with Crohn’s disease who lose response to anti-TNF treatment: a randomised, controlled trial

“…Changing to a different TNF inhibitor or another class of biological agent, if available, optimisation of conventional immunosuppressive drugs and/or surgery may also be considered 3–5. This treatment strategy may not always be optimal, as it may take a long time to regain control of inflammatory activity, leading to increased risk of irreversible tissue damage 6. Moreover, the dose intensification strategy is obviously very expensive, and anti-TNF biopharmaceuticals, which are also extensively used for a number of other chronic inflammatory diseases, now constitute one of the heaviest medicinal expenditures in Western countries 7…”