TY - JOUR
T1 - Biologic therapy in inflammatory bowel disease
AU - Theede, Klaus
AU - Dahlerup, Jens Frederik
AU - Fallingborg, Jan
AU - Hvas, Christian Lodberg
AU - Kjeldsen, Jens
AU - Munck, Lars Kristian
AU - Nordgaard-Lassen, Inge
AU - Danish Society of Gastroenterology and Hepatology
PY - 2013/6
Y1 - 2013/6
N2 - In luminal Crohn's disease with moderate to severe inflammatory activity, infliximab and adalimumab can be used in the case of treatment failure with conventional therapies, such as systemic steroids and immunosuppressive therapy or if this treatment is not tolerated. Further treatment strategy depends on the primary response to induction therapy Effect of maintenance therapy should be evaluated clinically and paraclinically at least every 26-52 weeks, and maybe supplemented by endoscopy or MRI scan Decision of treatment discontinuation is based on disease manifestation, treatment response and paraclinical parameters In fistulising Crohn's disease, treatment with infliximab or adalimumab can be initiated in simple fistula with rectal inflammation or complex fistula when the initial treatment has insufficient effect. Further treatment strategy depends on the primary response to induction therapy Maintenance therapy is often necessary in complex fistulas Treatment efficacy and possible discontinuation of treatment is evaluated at least every 26-52 weeks - if possibly with diagnostic imaging In acute severe ulcerative colitis, treatment with infliximab can be used in patients with partial response after 3-5 days of treatment with a high-dose systemic steroid and when surgical treatment is not preferred or required. Further treatment strategy depends on the response to the first drug administration and colectomy should always be considered as an option Effect of subsequent initiated maintenance therapy should be evaluated at least every 26-52 weeks on the basis of symptoms, clinical markers, paraclinical parameters and possibly by endoscopy In chronic active ulcerative colitis, infliximab and adalimumab can be used in the case of treatment with immunosuppressive therapy fails and if surgery is not preferred. Further treatment strategy depends on the response to induction therapy Treatment efficacy is assessed by symptoms, clinical markers, paraclinical parameters and possibly by endoscopy Effect of maintenance therapy should be evaluated at least every 26-52 weeks During treatment with biologic drugs focus should be on possible complications, such as infections, infusion or injection reactions and dermatological side effects. An overview of levels of evidence and recommendations is presented I table 4.
AB - In luminal Crohn's disease with moderate to severe inflammatory activity, infliximab and adalimumab can be used in the case of treatment failure with conventional therapies, such as systemic steroids and immunosuppressive therapy or if this treatment is not tolerated. Further treatment strategy depends on the primary response to induction therapy Effect of maintenance therapy should be evaluated clinically and paraclinically at least every 26-52 weeks, and maybe supplemented by endoscopy or MRI scan Decision of treatment discontinuation is based on disease manifestation, treatment response and paraclinical parameters In fistulising Crohn's disease, treatment with infliximab or adalimumab can be initiated in simple fistula with rectal inflammation or complex fistula when the initial treatment has insufficient effect. Further treatment strategy depends on the primary response to induction therapy Maintenance therapy is often necessary in complex fistulas Treatment efficacy and possible discontinuation of treatment is evaluated at least every 26-52 weeks - if possibly with diagnostic imaging In acute severe ulcerative colitis, treatment with infliximab can be used in patients with partial response after 3-5 days of treatment with a high-dose systemic steroid and when surgical treatment is not preferred or required. Further treatment strategy depends on the response to the first drug administration and colectomy should always be considered as an option Effect of subsequent initiated maintenance therapy should be evaluated at least every 26-52 weeks on the basis of symptoms, clinical markers, paraclinical parameters and possibly by endoscopy In chronic active ulcerative colitis, infliximab and adalimumab can be used in the case of treatment with immunosuppressive therapy fails and if surgery is not preferred. Further treatment strategy depends on the response to induction therapy Treatment efficacy is assessed by symptoms, clinical markers, paraclinical parameters and possibly by endoscopy Effect of maintenance therapy should be evaluated at least every 26-52 weeks During treatment with biologic drugs focus should be on possible complications, such as infections, infusion or injection reactions and dermatological side effects. An overview of levels of evidence and recommendations is presented I table 4.
KW - Anti-Inflammatory Agents, Non-Steroidal
KW - Antibodies, Monoclonal
KW - Antibodies, Monoclonal, Humanized
KW - Biological Therapy
KW - Humans
KW - Inflammatory Bowel Diseases
KW - Severity of Illness Index
M3 - Journal article
C2 - 23743116
SN - 0041-5782
VL - 60
SP - B4652
JO - Ugeskrift for Laeger
JF - Ugeskrift for Laeger
IS - 6
ER -