Division of Gastroenterology, Instituto Clinico Humanitas, IRCCS in Gastroenterology, Via Manzoni 56, Rozzano, Milan, Italy.
Aliment Pharmacol Ther. 2011 Apr;33(8):857-69. doi: 10.1111/j.1365-2036.2011.04598.x. Epub 2011 Feb 15.
Crohn's disease is a progressive condition, with most patients developing a penetrating or stricturing complication over time. A decade ago, treatment goals consisted of immediate symptomatic control. The introduction of anti-tumour necrosis factor (anti-TNF) therapies, however, has changed the way patients with Crohn's disease are treated. Over 10 years of clinical data and experience have demonstrated these therapies to be highly effective in Crohn's disease.
To provide clinicians guidance on optimising treatment with anti-TNF therapies in Crohn's disease by introducing an evidence- and personal opinion-based treatment algorithm using infliximab initial anti-TNF therapy.
Scientific literature was reviewed using MEDLINE to evaluate data on clinical trials with infliximab in luminal and fistulising Crohn's disease.
The data from several landmark infliximab trials have changed clinical practice and led to a readjustment of treatment goals in Crohn's disease, allowing patients to achieve more than just symptomatic relief including sustained steroid-free remission. Infliximab induces complete mucosal healing and reduces the rates of hospitalisation and surgery. Based on disease-related risk factors, a treatment algorithm for infliximab is delineated in favour of a rapid step-up approach in patients at high risk for a disabling course of disease.
Adopting the suggested treatment algorithm for infliximab into clinical routine is aimed to optimise outcomes for patients with Crohn's disease.
克罗恩病是一种进行性疾病，大多数患者随着时间的推移会发展为穿透性或狭窄性并发症。十年前，治疗目标是立即控制症状。然而，抗肿瘤坏死因子（anti-TNF）治疗的引入改变了克罗恩病患者的治疗方式。超过 10 年的临床数据和经验表明，这些疗法在克罗恩病中非常有效。
通过引入基于英夫利昔单抗初始抗 TNF 治疗的基于证据和个人意见的治疗算法，为临床医生在克罗恩病中优化抗 TNF 治疗提供指导。
使用 MEDLINE 审查科学文献，以评估英夫利昔单抗在腔性和瘘管性克罗恩病中的临床试验数据。
几项具有里程碑意义的英夫利昔单抗试验的数据改变了临床实践，并导致克罗恩病的治疗目标重新调整，使患者不仅能获得症状缓解，还能实现持续无类固醇缓解。英夫利昔单抗诱导完全黏膜愈合，并降低住院和手术率。基于疾病相关的风险因素，为英夫利昔单抗制定了治疗算法，有利于对疾病病程可能致残风险高的患者进行快速升级治疗。
将建议的英夫利昔单抗治疗算法纳入临床常规，旨在优化克罗恩病患者的治疗结果。
