Although many drugs have been used in the treatment of inflammatory bowel disease, none have yet been shown to modify the natural history of the diseases or to maintain a stable remission over time. The introduction of biological agents in the therapeutic armamentarium for Crohn's disease and ulcerative colitis has significantly changed the treatment strategies and outcomes of patients. Infliximab scheduled treatment has proven to be an effective strategy in IBD patients for long-term maintenance of clinical remission.
Crohn's disease (CD) and ulcerative colitis (UC) are chronic-relapsing diseases, the clinical courses of which are characterized by periods of remission and periods of acute flare up, determining clinical symptoms which have a strong impact on the quality of life for patients.
For many years, corticosteroids have represented the cornerstone of therapy for induction of remission in Inflammatory Bowel Disease (IBD); however, the side-effects emerging with long-term use exceeded the clinical benefits. Recently, Infliximab (IFX) has become an alternative choice in the treatment strategies for CD and UC.
Some safety issues are associated with IFX use, mostly related to the development of adverse events (e.g. opportunistic infections, autoimmune disorders and infusion reactions).
Major concerns are related to the reactivation of latent tuberculosis and development of malignancy, even if there is no clear evidence the use of IFX increases the incidence of solid cancers.
The research published on issue 39 of World Journal of Gastroenterology and led by Renato Caviglia at University Campus Biomedico in Italy aimed to retrospectively evaluate the safety and efficacy of long-term therapy with IFX, reviewing the medical charts of 41 IBD patients who received, after a loading dose of 3 IFX infusions, scheduled retreatment every 8 weeks as maintenance protocol.
Results of this retrospective study confirm current data on the efficacy of IFX in inducing a rapid clinical response in CD and UC, and support the finding, emerging from uncontrolled study data, of prolonged clinical efficacy in maintaining long-lasting remission beyond 1 year of treatment. The steroid-sparing effect of IFX was another important finding emerging from our study, which confirmed the efficacy of a scheduled treatment regimen in avoiding the well-known morbidity associated with long-term corticosteroid therapy.
Interestingly, long-term IFX therapy in IBD has been demonstrated to potentially modify the course of the disease. Indeed, 9 out of the 29 CD and 4 out of the 9 UC patients, who discontinued IFX scheduled treatment, were still relapse-free after a median of 16 (range, 5-30) and 6.5 (range, 4-16) months since the last IFX infusion, respectively.
A note of caution is mandatory when considering the possible risk of malignancy associated with the use of anti-TNF-alpha therapy. Further studies on larger scales are needed to further clarify these important aspects.
Reference: Caviglia R, Ribolsi M, Rizzi M, Emerenziani S, Annunziata ML, Cicala M. Maintenance of remission with infl iximab ininfl ammatory bowel disease: Effi cacy and safety long-termfollow-up. World J Gastroenterol 2007; 13(39): 5238-5244
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