GASTROENTEROLOGY LITERATURE ALERT

GASTROENTEROLOGY LITERATURE ALERT!

LANDMARK ARTICLE - Required reading

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;340:1398-405.

Major findings:

68% of patients treated with infliximab achieved a reduction of >50% in the number of draining fistulas, compared to 26% of patients on placebo
55% of patients treated with infliximab achieved closure of all fistulas compared to 13% of those on placebo.
Infliximab was most effective when administered as a 5 mg/kg dose. Infusion was repeated at week 2 and 6.
Higher doses of infliximab were not more effective, if anything, efficacy decreased with higher doses
Improvement was rapid - evident by 2 weeks after first treatment
Most common side effects associated with infliximab use were headaches, abscess, upper respiratory tract infection and fatigue.
Patients were kept on their previous medications while receiving infliximab infusions.

FACTS TO REMEMBER FOR BOARDS

Infliximab is a genetically constructed IgG type 1 murine-human chimeric monoclonal antibody that binds the membrane-bound precursor of TNF-alfa (tumor necrosis factor alfa) – ie infliximab is a TNF-a blocker
Infliximab is marketed under the trade name "Remicade"
TNF-a has a key role in the initiation and propagation of Crohn’s disease, and levels of TNF-a are increased in patients with Crohn’s disease

Clinical application

Infliximab (Remicade) is emerging as an important tool in the treatment of patients with enterocutaneous fistulas secondary to Crohn’s disease.
At present, its used is restricted to those who failed other therapies - corticosteroids and immunosuppressants
For enterocutaneous fistulas, infusions should be repeated 2 and 6 weeks after the initial infusion

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