GASTROENTEROLOGY LITERATURE ALERT!

LANDMARK ARTICLE - Required reading

• This study shows endoscopic and histologic healing in response to infliximab, two objectives that are rarely accomplished with corticosteroid treatment of Crohn’s disease
• Crohn’s disease activity decreased significantly in most infliximab-treated patients
• There was no dose-related response. Best response was achieved with the 5mg/kg infusion dose.
• Endoscopic and histologic improvement was evident 4 weeks after the intravenous administration of a single infusion of infliximab.
• Endoscopic improvement was observed in most treated patients and in none of the placebo patients.
• Disappearance of the inflammatory infiltrate on histology was observed in infliximab-treated patients, but in none of the placebo-treated subjects.
• Strictures developed in several patients as the ulcers healed.
• Previously present stenotic areas did not improve with infliximab
• How long this positive response lasted was not evaluated in this study
• This was a small study, 30 patients were included

• Clinical response achieved with corticosteroids is associated with mucosal healing in only 29% of patients - most improve symptomatically but not endoscopically
• Mucosal healing (as assessed by endoscopy) virtually never occurs with corticosteroid therapy alone, despite the fact that patients improve clinically
• For the treatment of Crohn’s disease without fistulas, only one infusion of infliximab is indicated. It is not clear if repeated infusions are needed for maintenance.

Clinical application

• Infliximab is indicated for refractory Crohn’s disease, even in the absence of fistulas
• Treatment of non-fistulous disease consists of one infusion only, using 5mg/kg dose
• Stenotic (fibrotic) disease does not respond to infliximab. Strictures can form as ulcerated disease heals in response to infliximab.

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