Pelletier A-L, Kalisazan B, Wienckiewicz J, Bouarioua N, Soulé J-C
Service d'Hépato-gastroentérologie, Hôpital Bichat, 46 rue Huchard, 75877 Paris cedex 18, France.
Aliment Pharmacol Ther. 2009 Feb 1;29(3):279-85. doi: 10.1111/j.1365-2036.2008.03887.x. Epub 2008 Nov 8.
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.
To evaluate the effect of infliximab on symptomatic strictures of the small intestine in CD and to identify predictive factors of clinical response.
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.
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.
Infliximab may be effective in patients with symptomatic strictures from CD, and should be tested before considering surgery.
一些报告表明英夫利昔单抗可能诱发梗阻症状，尽管尚无确凿证据，但通常对患有克罗恩病（CD）和狭窄的患者禁用。
评估英夫利昔单抗对CD患者小肠症状性狭窄的影响，并确定临床反应的预测因素。
这项回顾性研究纳入了常规治疗失败后接受英夫利昔单抗治疗的有症状患者。短期（第8周）和长期结果根据预定义标准分为完全缓解、部分缓解或失败。
在使用英夫利昔单抗之前，18例患者有完全性梗阻或间歇性慢性腹痛。14例患者接受了皮质类固醇治疗，13例接受了免疫抑制药物治疗。在第8周时，分别有10例、7例和1例患者出现完全缓解、部分缓解和治疗失败。14例患者在第8周后继续接受英夫利昔单抗维持治疗。在最近一次评估（中位随访时间：18个月）时，8例患者正在接受英夫利昔单抗维持治疗；只有8例仍在使用泼尼松；有5例完全缓解，10例部分缓解和3例治疗失败。开始使用泼尼松或增加其剂量是与短期完全缓解相关的唯一因素。
英夫利昔单抗可能对CD症状性狭窄患者有效，在考虑手术前应进行试验。
