TITLE

Infliximab in inflammatory bowel disease: clinical outcome in a population based cohort from Stockholm County

AUTHOR(S)
Ljung, T.; Karlén, P.; Schmidt, D.; Hellström, P. M.; Lapidus, A.; Janczewska, I.; Sjöqvist, U.; Löfberg, R.
PUB. DATE
June 2004
SOURCE
Gut;Jun2004, Vol. 53 Issue 6, p849
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Several placebo controlled studies have demonstrated the efficacy of infliximab in inflammatory bowel disease (IBD) but the potential toxicity of this new biological compound has been less studied. Aim: To assess the use of infliximab in IBD in a population based cohort, with special emphasis on the occurrence of severe adverse events and mortality. Patients: All patients with IBD treated with infliximab between 1999 and 2001 in Stockholm County were evaluated. Methods: Prospective registration of clinical data was carried out. Retrospective analyses were made of possible adverse events occurring in relation to infliximab treatment. Adverse events requiring pharmacological treatment or hospitalisation were defined as severe. Clinical response was assessed as remission, response, or failure. Results: A cohort comprising 217 patients was assembled: 191 patients had Crohn's disease (CD), and infliximab was used off label for ulcerative colitis (UC) in 22 patients. Four patients were treated for indeterminate colitis (IC). Mean age was 37.6 (0.9) years (range 8-79). The mean number of infliximab infusions was 2.6 (0.1) (range 1-11). Forty two severe adverse events were registered in 41 patients (CD, n = 35). Eleven of the severe adverse events occurred postoperatively (CD, n = 6). Three patients with CD developed lymphoma (of which two were fatal), opportunistic infections occurred in two patients (one with UC, fatal), and two patients with severe attacks of IBD died due to sepsis (one with CD, one postoperatively with UC). One additional patient with UC died from pulmonary embolism after colectomy. Mean age in the group with fatal outcome was 62.7 years (range 25-79). The overall response rate was 75% and did not differ between the patient groups. Conclusions: Infliximab was efficacious as an anti-inflammatory treatment when assessed in a population based cohort of patients with IBD. However, there appear to be a significant risk of deleterious and fatal adverse events, particularly in elderly patients with severe attacks of IBD. Off label use of infliximab in UC and IC should be avoided until efficacy is proven in randomised controlled trials. The underlying risk of developing malignancies among patients with severe or chronically active CD in need of infliximab treatment is not known but the finding of a 1.5% annual incidence of lymphoma emphasises the need for vigilant surveillance with respect to this malignant complication.
ACCESSION #
13354301

 

Related Articles

  • Loss of Response and Requirement of Infliximab Dose Intensification in Crohn's Disease: A Review. Gisbert, Javier P.; Panés, Julián // American Journal of Gastroenterology;Mar2009, Vol. 104 Issue 3, p760 

    OBJECTIVES:To review the frequency with which infliximabloses its effect and dose “intensification” is required for Crohn's disease treatment.METHODS:Bibliographical searches were performed in MEDLINE, and European (ECCO) and American (DDW) Congresses. Studies evaluating loss of...

  • Infliximab: A Review of its use in the Treatment of Pediatric Crohn's Disease. Broder, Arkady; Rosh, Joel R. // Clinical Medicine Insights: Therapeutics;2010, Issue 2, p235 

    The past decade has brought great change to the treatment of pediatric Crohn's disease. The majority of affected patients now receive therapy directed at the underlying immune dysregulation that is associated with this chronic disease. The monoclonal antibodies directed against tumor necrosis...

  • Locking the Door to Leukocytes: Use of Integrin Inhibitors for the Treatment of Crohn's Disease. Dryden. Jr, Gerald W. // Clinical Medicine Insights: Therapeutics;2010, Issue 2, p897 

    Inflammatory Bowel Disease (IBD) treatments are rapidly evolving. Current knowledge of the immunopathology responsible for IBD grows on a daily basis. These scientific discoveries are quickly being translated into clinical advances for improved treatment of IBD patients. The breakthrough in...

  • TNF blockers the future for Crohn's. Pownall, Mark // GP: General Practitioner;6/2/2006, p8 

    The article informs that clinical trial results suggest that Crohn's disease patients treated with TNF-alpha inhibitors can reach and maintain remission. Currently, Crohn's disease is treated with steroids which reduce inflammatory flares of the disease, but have no benefits in inducing...

  • INFLAMMATORY BOWEL DISEASE.  // Current Medical Literature: Gastroenterology;2004, Vol. 23 Issue 2, p47 

    Presents several abstracts of the articles related to gastroenterology. "A Randomised Placebo Controlled Trial of Pegylated Interferon Alpha in Active Ulcerative Colitis," by H. Tilg, H. Vogelsang, O. Ludwiczek, H. Lochs, A. Kaser, and J. F. Colombel; "The Safety Profile of Infliximab in...

  • Biologic Therapies Against Inflammatory Bowel Disease: A Dysregulated Immune System and the Cross Talk with Gastrointestinal Mucosa Hold the Key. Dharmani, Poonam; Chadee, Kris // Current Molecular Pharmacology;Nov2008, Vol. 1 Issue 3, p195 

    Inflammatory bowel disease (IBD) is a GI tract disorder that manifests as either Ulcerative colitis (UC) or Crohn's disease (CD). The precise etiology of IBD is still not completely elucidated but research into the immunopathogenesis of IBD suggests that dysfunctions of the intestinal immune...

  • Infliximab in inflammatory bowel disease: attention to adverse events. UYANIKOGLU, A.; ERMIS, F.; AKYUZ, F.; PINARBASI, B.; BARAN, B.; AYDOGAN, T.; DEMIR, K.; BESISIK, F.; KAYMAKOGLU, S. // European Review for Medical & Pharmacological Sciences;2014, Vol. 18 Issue 16, p2337 

    OBJECTIVE: TO assess the efficacy and adverse effects of infliximab in patients with Crohn's disease and ulcerative colitis who are resistant to conventional therapy or having fistulising type Crohn's disease. PATIENTS AND METHODS: The patients with a diagnosis of inflammatory bowel disease...

  • Adalimumab strides forward in Crohn's disease.  // PharmacoEconomics & Outcomes News;9/19/2009, Issue 587, p5 

    The article discusses research which compared the cost effectiveness of adalimumab and infliximab for treating severely active Crohn's disease. It references a study by A. P. Yu et al published in the July 2009 issue of the journal "PharmacoEconomincs." Results of the study showed that fewer...

  • Infliximab: the evidence for its place in therapy in ulcerative colitis. Assche, Gert Van; Vermeire, Séverine; Rutgeerts, Paul // Core Evidence;2007, Vol. 2 Issue 3, p151 

    Introduction: Refractory ulcerative colitis has a high, unmet medical need for avoiding steroid dependency and avoiding colectomy. Controlled trials with biologic agents have recently been reported. Aims: We aimed to review the current evidence supporting the use of the monoclonal antitumor...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sign out of this library

Other Topics