Infliximab treatment for symptomatic Crohn’s disease strictures

Summary Background Some reports have suggested that infliximab may induce obstructive symptoms and, although there is no firm evidence, it is usually contra‐indicated in‐patients with Crohn’s disease (CD) and strictures. Aims To evaluate the effect of infliximab on symptomatic strictures of the sm...

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Published in:	Alimentary pharmacology & therapeutics Vol. 29; no. 3; pp. 279 - 285
Main Authors:	PELLETIER, A.‐L., KALISAZAN, B., WIENCKIEWICZ, J., BOUARIOUA, N., SOULÉ, J.‐C.
Format:	Journal Article
Language:	English
Published:	Oxford, UK Blackwell Publishing Ltd 01-02-2009 Blackwell
Subjects:	Adolescent Adult Aged Antibodies, Monoclonal - administration & dosage Antibodies, Monoclonal - pharmacokinetics Biological and medical sciences Constriction, Pathologic - drug therapy Constriction, Pathologic - etiology Crohn Disease - complications Crohn Disease - drug therapy Digestive system Dose-Response Relationship, Drug Female Gastroenterology. Liver. Pancreas. Abdomen Gastrointestinal Agents - administration & dosage Gastrointestinal Agents - pharmacokinetics Humans Ileal Diseases - drug therapy Ileal Diseases - etiology Infliximab Infusions, Intravenous Male Medical sciences Middle Aged Other diseases. Semiology Pharmacology. Drug treatments Remission Induction - methods Retrospective Studies Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Treatment Outcome Young Adult Cytokine Stenosis Monoclonal antibody Anti-Tumor Necrosis Factor-alpha Inflammatory disease Immunomodulator Crohn disease Treatment Infliximab Anticytokine Digestive diseases Intestinal disease Immunosuppressive agent Tumor necrosis factor α
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Summary:	Summary Background Some reports have suggested that infliximab may induce obstructive symptoms and, although there is no firm evidence, it is usually contra‐indicated in‐patients with Crohn’s disease (CD) and strictures. Aims To evaluate the effect of infliximab on symptomatic strictures of the small intestine in CD and to identify predictive factors of clinical response. Methods This retrospective study included symptomatic patients treated with infliximab after conventional treatment had failed. The short‐term (week 8) and long‐term results were classified according to predefined criteria as complete, partial response, or failure. Results Before infliximab, 18 patients had complete obstruction or intermittent chronic abdominal pain. Fourteen patients were treated by corticosteroids and 13 received immunosuppressive drugs. At week 8, complete, partial response and failure were observed in 10, 7 and 1 patients, respectively. Fourteen patients continued maintenance infliximab treatment after week 8. During the most recent evaluation (median follow‐up: 18 months), 8 patients were on maintenance infliximab treatment; only eight were still on prednisone; there were five complete responses, 10 partial responses and three failures. Initiating prednisone or increasing its dosage was the only factor associated with a short‐term complete response. Conclusions Infliximab may be effective in patients with symptomatic strictures from CD, and should be tested before considering surgery.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0269-2813 1365-2036
DOI:	10.1111/j.1365-2036.2008.03887.x