TREATMENT OF CROHN’S DISEASE BY INFLIXIMAB. ABOUT 20 CASES.

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Published Dec 3, 2009
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Vol. 87 No. 9 (2009): Issue Sep 2009

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Meriem Serghini
Sami Karoui
Mayssoun Meknini
Samira Matri
Lamia Kallel
Monia Fekih
Jalel Boubaker
Azza Filali

Abstract

Background : Infliximab has been an effective chimerical monoclonal antibody in Crohn’s disease. Infliximab is available in Tunisia for a few years.
Aims: To determine the results of the treatment of Crohn’s disease by infliximab.
Methods: We undertook a retrospective study relating to all the Crohn’s disease patients and treated by infliximab. For all the patients, we specified the indication of the treatment, the result of the induction treatment, the recourse or not to a sequential treatment and the adverse effects of the treatment.
Results: Our study related to 20 patients. It was in the majority of the cases an anoperineal and fistulizing form (15 case). Good response to the induction treatment was noted in 15 patients (75%). A sequential treatment by infliximab was undertaken among seven patients, with good results in the short and medium term. A case of death related to the treatment was noted in our series, as mortal milliary tuberculosis appeared under treatment.
Conclusion: Infliximab must be reserved for particular situations of the Crohn’s disease. The pre-therapeutic assessment must be complete and the monitoring of the patients must be strict, while insisting on the possibility of reactivation of latent tuberculosis in Tunisia.

Keywords:

Crohn's disease, Infliximab

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References

  1. Bell SJ, Kamm MA. The clinical role of anti-TNF alpha antibody treatment in Crohn's disease. Aliment Pharmcol Ther 2000;14:501-14.
  2. Sandborn WJ, Hanauer SB. Infliximab in the treatment of Crohn's disease: a user's guide for clinicians. Am J Gastroenterol 2002;97:2962-72.
  3. Karoui S, Boubaker J, Filali A. Indications et résultats de l'infliximab au cours de la maladie de Crohn. Tunis Med 2004 ;82 :1057-63.
  4. Knight DM, Trinh H, Le J et al. Construction and initial characterization of a mouse-human chimeric anti-TNF antibody. Mol Immunol 1993;30:1443-53.
  5. Travis SPL, Stange EF, Lémann M et al. European evidence-based consensus on the management of ulcerative colitis: Current management. J Crohn's Colitis 2008;2:24-62.
  6. Travis SPL, Stange EF, Lémann M et al. European evidence-based consensus on the diagnosis and management of Crohn's disease: Current management. Gut 2006;55(Suppl 1):i16-i35.
  7. Targan SR, Hanauer SB, van Deventer SJH et al. A short-term study on chimeric monoclonal antibody cA2 to tumor necrosis factor alpha in Crohn's disease. Crohn's disease cA2 Study Group. N Engl J Med 1997;337:1029-35.
  8. Present DH. Crohn's fistula: current concepts and management. Gastroenterology 2003;124:1629-35.
  9. Present DH, Rutgeerts P, Targan S et al. Infliximab for the treatment of fistula in patients with Crohn's disease. N Engl J Med 1999;340:1398-405.
  10. Hanauer SB, Feagan BG, Lichtenstein GR et al. Maintenance infliximab for Crohn's disease: the ACCENT 1 randomised trial. Lancet 2002;359-1541-9.
  11. Sands B, Anderson FH, Bernstein CN et al. Infliximab maintenance therapy for fistulizing Crohn's disease. N Engl J Med 2004;350:76- 85.
  12. Kinney T, Rawlins M, Kozarek R et al. Immunomodulators and “on demand” therapy with infliximab in Crohn's disease. Clinical experience with 400 infusions. Am J Gastroenterol 2003;98:608-12.
  13. Colombel JF, Sandborn WJ, Rutgeerts P et al. Adalimumab for maintenance of clinical response and remission in patients with Crohn's disease: The CHARM trial. Gastroenterology 2007;132:52- 65.
  14. Sandborn WJ, Feagan BG, Stoinov S et al. Certolizumab pegol for the treatment of Crohn's disease. N Engl J Med 2007;357:228-38.
  15. Baert F, Noman M, Vermeire S et al. Influence of immunogenicity on the long term efficacy of infliximab in Crohn's disease. N Engl J Med 2003;348:601-8.
  16. Travis SPL. Infliximab and azathioprine : bridge or parachute ? Gastroenterology 2006 ;130 :1354-7.
  17. Zeidan A, Sham R, Shapiro J, Baratta A, Kouides P. Hepatosplenic Tcell lymphoma in a patient with a Crohn's disease who received infliximab therapy. Leuk Lymphoma 2007;48:1410-3.
  18. Colombel JF, Loftus EV Jr, Tremaine WJ et al. The safety profile of infliximab in patients with Crohn's disease: The Mayo clinic experience on 500 patients. Gastroenterology 2004;126:19-31.
  19. Lichtenstein GR, Feagan BG, Cohen RD et al. Serious infections and mortality in association with therapies for Crohn's disease: TREAT registry. Clin Gastroenterol Hepatol 2006;4:621-30.
  20. Viget N, Vernier-Massouille G, Salmon-Ceron D, Yazdanpanah Y, Colombel JF. Opportunistic infections in patients with inflammatory bowel disease: prevention and diagnosis. Gut 2008;57:549-58.
  21. Tougeron D, Mauillon J, Tranvouez JL. Une varicelle grave lors d'un traitement par infliximab pour maladie de Crohn. Gastroenterol Clin Biol 2006 ;30 :1410-3.
  22. Salmon-Ceron D. Recommandations pour la prevention et la prise en charge de la tuberculose chez les patients sous infliximab. Ann Med Intern 2002 ;153 :429-31.
  23. Karoui S, Bouallegue L, Hamzaoui S, Filali A, Boubaker J. Miliaire tuberculeuse probable d'évolution mortelle après traitement par infliximab. Tunis Med 2004 ;82 :393-6.
  24. Esteve M, Saro C, Gonzalez-Huix F, Suarez F. Chronic hepatitis B reactivation following infliximab therapy in Crohn's disease patient : need for primary prophylaxis. Gut 2004;53:1363-5.
  25. Nathan DM, Angus PW, Gibson PR. Hepatitis B and C virus infection and tumor necrosis factor alpha therapy: Guidelines for clinical approach. J Gastroenterol Hepatol 2006;21:1366-71.