Pearce Callum B, Lawrance Ian C
Department of Gastroenterology, Fremantle Hospital, Freemantle, Western Australia, Australia.
J Gastroenterol Hepatol. 2007 Oct;22(10):1671-7. doi: 10.1111/j.1440-1746.2006.04739.x.
The use of infliximab in the treatment of Crohn's disease (CD) is acceptable and appears to be effective in ulcerative colitis (UC). Careful patient selection, resulting in infliximab only for truly refractory inflammatory bowel disease (IBD), may improve its efficacy. The present study aimed to determine if careful patient selection improved infliximab efficacy in IBD.
CD or UC/IBD unclassified patients (Montreal classification) were considered for infliximab treatment only after failure of disease control with conventional therapies and confirmation of active disease. Patients with purely luminal IBD received a single infliximab dose. Patients with fistulizing disease (with or without luminal disease) received infliximab at 0, 2 and 6 weeks. Changes to Harvey Bradshaw (HBI) for inflammatory CD and Colitis Activity Index (CAI) for UC/IBDU were used to determine the response and remission rates. In fistulizing CD, a remission was sustained cessation of drainage and resolution of the fistula. Response was correlated to inflammatory marker levels.
Seventy IBD patients were treated. In CD, 85.2% (46/54) had active luminal and 40.7% (22/54) had fistulizing disease. In luminal CD, at 8 weeks a single infliximab dose induced remission in 75% (24/32) of patients compared to 92.9% (13/14) after infliximab at 0, 2 and 6 weeks. Fistulizing disease responded in 77.2% (17/22) and remitted in 50% (11/22) of patients at 8 weeks. In UC/IBDU, 75% (12/16) responded and 43.8% (7/16) of patients were in remission at 8 weeks.
Careful patient selection may improve infliximab's efficacy and clinical remission appears greater after induction with three infliximab doses in CD. Clinical efficacy is suggested for UC/IBDU.
英夫利昔单抗用于治疗克罗恩病（CD）是可接受的，且在溃疡性结肠炎（UC）中似乎有效。仔细选择患者，仅将英夫利昔单抗用于真正难治性炎症性肠病（IBD），可能会提高其疗效。本研究旨在确定仔细选择患者是否能提高英夫利昔单抗在IBD中的疗效。
仅在传统治疗未能控制疾病且确诊为活动性疾病后，才考虑对CD或未分类的UC/IBD患者（蒙特利尔分类）使用英夫利昔单抗治疗。单纯腔内型IBD患者接受单次英夫利昔单抗剂量治疗。瘘管型疾病患者（无论有无腔内疾病）在第0、2和6周接受英夫利昔单抗治疗。使用炎症性CD的哈维·布拉德肖指数（HBI）和UC/IBD未分类的结肠炎活动指数（CAI）的变化来确定缓解率和应答率。在瘘管型CD中，缓解定义为引流持续停止且瘘管消退。应答与炎症标志物水平相关。
70例IBD患者接受了治疗。在CD中，85.2%（46/54）有活动性腔内病变，40.7%（22/54）有瘘管型疾病。在腔内型CD中，单次英夫利昔单抗剂量在8周时使75%（24/32）的患者达到缓解，而在第0、2和6周接受英夫利昔单抗治疗后，缓解率为92.9%（13/14）。瘘管型疾病在8周时77.2%（17/22）的患者有应答，50%（11/22）的患者达到缓解。在UC/IBD未分类中，75%（12/16）的患者有应答，43.8%（7/16）的患者在8周时达到缓解。
仔细选择患者可能会提高英夫利昔单抗的疗效，在CD中，三次英夫利昔单抗诱导治疗后临床缓解似乎更明显。UC/IBD未分类也显示出临床疗效。
