Current position and future trends of therapy for Crohn’s disease

Česká verzia

Authors: M. Lukáš
Authors place of work: Klinické a výzkumné centrum pro střevní záněty, ISCARE I. V. F. a. s. a Ústav lékařské biochemie a laboratorní diagnostiky 1. LF UKa VFN v Praze
Published in the journal: Gastroent Hepatol 2013; 67(4): 306-312
Category: IBD: Review Article

Summary

Despite significant progress in the therapy of Crohn´s disease, many problems and unsolved approaches still remain. In this review the author identifies and discusses some of them. Major consideration is focused on therapy of perianal Crohn´s disease, on combination therapy with immunomodulators, and biologic therapy including the advantages and limitations of each. Additionally, the approach to patients after surgery and the choice of prophylactic therapy is discussed. At the end of this paper the position of musosal healing in Crohn´s disease patients is discussed. It is recognized that mucosal healing has great importance for patients' prognosis after therapy has started, but an endoscopic evaluation of mucosal healing in Crohn´s disease partients is far more problematic in comparision to ulcerative colitis patients. This is one reason why monitoring of mucosal healing is not currently standard clinical practice.

Key words:
Crohn´s disease – biological therapy – infliximab

The author declares he has no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
29. 7. 2013

Accepted:
14. 8. 2013

Zdroje

1. Lukáš M. Současnost a budoucnost v léčbě ulcerózní kolitidy. Gastroent Hepatol 2013; 67(3): 212–218.

2. Bortlík M. Současný pohled na léčbu perianálních píštělí u nemocných s Crohnovou chorobou. Gastroent Hepatol 2013; 67(1): 25–29.

3. Present DH, Rutgeerts P, Targan S et al. Infliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med 1999; 340(18): 1398–1405.

4. Sands BE, Anderson FH, Bernstein CN et al. Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med 2004; 350(9): 876–885.

5. Bouguen G, Siproudhis L, Gizard E et al. Long-term outcome of perianal fistulazing Crohn´s disease treated with infliximab. Clin Gastroenterol Hepatol 2013; 11(8): 975–981.

6. Colombel JF, Sandborn WJ, Reinisch W et al. Infliximab, azathioprine, or combination therapy for Crohn’s disease. N Engl J Med 2010; 362(15): 1383–1395.

7. Panaccione R, Ghosh S, Middleton S et al. Infliximab, Azathioprine, or Infliximab + Azathioprine for Treatment of Moderate to Severe Ulcerative Colitis: The UC Success Trial. Gastroenterology 2011; 140: 134.

8. Rahier JF, Ben-Horin S, Chowers Y et al. European evidence-based Consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis 2009; 3(2): 47–91.

9. Jones et al. Impact of concomitant immunomodulators treatment on efficacy and safety of anti-TNF therapy in Crohn´s disease: Meta-analysis of placebo controlled trials with individual patiens-level data. Orlando: DDW 2013: (Abstract).

10. Haggai BY, Chowers Y, Ben-Horin S et al. Infliximab is more immunogenic and reaches lower through levels in ulcerative colitis patients compared to Crohn´s disease patients. Orlando: DDW 2013: (Abstract): Tu 1167.

11. Guilday C, Eastwood D, Zadvornova Y et al. Concomitant use of immunomodulators therapy results in higher infliximab levels compared to monotherapy wihout lowering serum HACA levels. Orlando: DDW 2013: (Abstract): Su 1213.

12. Lukáš M. Imunosupresivní a biologická léčba u CN „šitá na míru“. Komentář ke studii STORI. Gastroent Hepatol 2013; 67(1): 65–69.

13. Bortlik M, Duricova D, Malickova K et al. Infliximab trough levels may predict sustained response to infliximab in patients with Crohn´s disease. J Crohns Colitis 2012; doi: 10.1016/j.crohns.2012.10.019.

14. Peyrin-Biroulet L, Deltenre P, de Suray N et al. Efficacy and safety of tumor necrosis factor antagonists in Crohn´s disease: meta-analysis of placebo-controlled trials. Clin Gastroenterol Hepatol 2008; 6(6): 644–653.

15. Dignass A, Van Assche G, Lindsay JO et al. The second European evidence-based Consensus on the diagnosis and management of Crohn´s disease: Current management. J Crohns Colitis 2010; 4(1): 28–62.

16. D’Haens GR, Vermeire S, Van Assche G et al. Therapy of metronidazole with azathioprine to prevent postoperative recurrence of Crohn’s disease: a controlled randomized trial. Gastroenterology 2008; 135(4): 1123–1129.

17. Ford AC, Khan KJ, Achkar JP et al. Efficacy of oral vs. topical, or combined oral and topical 5-aminosalicylates, in ulcerative colitis: systematic review and meta-analysis. Am J Gastroenterol 2012; 107(2): 167–176.

18. Reinisch W, Angelberger S, Petritsch W et al. Azathioprine versus mesalazine for prevention of postoperative clinical recurrence in patients with Crohn’s disease with endoscopic recurrence: efficacy and safety results of a randomised, double-blind, double-dummy, multicentre trial. Gut 2010; 59(6): 752–759.

19. Regueiro M, Baidoo L, Kip KE et al. Infliximab maintenance beyond one year prevents postoperative Crohn´s disease recurrence: Long term follow-up from the randomized controlled pilot study. Orlando: DDW 2013: (Abstract): 954.

20. Modigliani R, Mary JY, Simon JF et al. Clinical, biological, and endoscopic picture of attacks of Crohn´s disease: Evolution on prednisolone. Gastroenterology 1990; 98(4): 811–818.

21. Allez M, Lemann M, Bonnet J et al. Long term outcome of patients with active Crohn’s disease exhibiting extensive and deep ulcerations at colonoscopy. Am J Gastroenterol 2002; 97(4): 947–953.

22. Baert F, Moortgat L, Van Assche G et al. Mucosal healing predicts sustained clinical remission in patients with early-stage Crohn’s disease. Gastroenterology 2010; 138(2): 463–468.

23. Rutgeerts P, Geboes K, Vantrappen G et al. Predictability of the postoperative course of Crohn’s disease. Gastroenterology 1990; 99(4): 956–963.

24. Machková N, Ďuricová D, Bortlík M et al. Hodnocení slizničního hojení v průběhu biologické léčby Crohnovy choroby tenkého střeva pomocí kapslové endoskopie: prospektivní observační studie. Gastroent Hepatol 2013; 67(1): 17–21.

25. De Cruz P, Kamm MA, Prideaux L et al. Mucosal healing in Crohn´s disease: a systematic review. Inflamm Bowel Dis 2013; 19(2): 429–444.

26. Colombel JF, Rutgeerts PJ, Sandborn WJ. Adalimumab treatment results in deep remission for patients with moderate to severe ileocolonic Crohn’s disease: results from EXTEND. Gastroenterology 2010; 138: S518.

27. Hebuterne X, Bouhnik Y, Dewit O et al. Endoscopic improvement in patients with active Crohn’s disease-treated with Certolizumab Pegol: First results of the MUSIC Clinical Trial. United European Gastroenterology Week 2008; OP073.

28. Laharie D, Reffet A, Belleannée G et al. Mucosal healing with methotrexate in Crohn’s disease: a prospective comparative study with azathioprine and infliximab. Aliment Pharmacol Ther 2011; 33(6): 714–721.