Effect of concurrent elemental diet on infliximab treatment for Crohn's disease

BACKGROUND: Infliximab and elemental diet (ED) have been shown to be effective in the management of Crohn's disease. However, few experiences have been reported regarding their combination therapy. The aim of the present study was to investigate the efficacy and safety of infliximab in Japanese patients, the first such study in Asia, as well as the effect of concomitant ED. METHODS: One hundred and ten consecutive patients receiving infliximab were followed up to week 16 after the last infusion, and clinical response and primary outcome were collected. A response was defined as a reduction in Harvey-Bradshaw Index for inflammatory disease and closure of fistula in fistulizing disease. RESULTS: Out of 75 inflammatory and 35 fistulizing disease patients, 68 (90.7%) and 25 (71.4%) responded at week 4, and 38 (50.7%) and 14 (40.0%) continued to respond until week 16, respectively. Interestingly, inflammatory disease patients with concurrent ED had a significantly higher response rate at week 16 (68.4%) than those without ED (32.4%, P = 0.0026). The effects of ED were independent of the usage of azathioprine and smoking habit. CONCLUSIONS: Infliximab was clinically useful in the treatment of Crohn's disease in Japanese patients as well as in those in Western countries. The efficacy of concurrent ED was suggestive and should be confirmed in a randomized controlled study.     

英夫利西治疗克罗恩病11例疗效观察

目的分析新型生物制剂英夫利西(infliximab,商品名:类克)治疗11例克罗恩病(CD)的疗效。方法前瞻性应用英夫利西治疗难治性性CD患者11例(活动期急性肠外瘘8例,激素及免疫抑制剂治疗无效CD患者3例)。在第0、2、6周分别给予5mg/kg作为基础剂量,14及22周分别给予相同剂量维持,临床及内镜随访。结果 (1)8例瘘道患者2、6、14和22周分别2例、4例、5例和6例治疗有效。3例常规治疗无效患者治疗后2例缓解,1例有效。(2)30周左右时内镜下黏膜愈合50%8例。(3)治疗前后WBC、CRP明显降低。结论英夫利西可诱导部分出现肠外瘘CD患者渗液量减少,部分患者瘘道完全闭合,同时可诱导并维持部分常规治疗无效的CD缓解,促进病变的黏膜愈合。     

Cystic fibrosis and Crohn’s disease:Successful treatment and long term remission with infliximab

The association of cystic fibrosis and Crohn‘s disease (CD) is well known, but to date, there are very few cas-es in the literature of patients suffering from mucovisci-dosis who have required treatment with infliximab. We report the case of a 23-year-old patient suffering from cystic fibrosis and severe CD treated successfully with infliximab without any infective complications or wors-ening of the pulmonary disease and with a long term (2 years) complete remission.     

Guidelines for treatment with infliximab for Crohn's disease

Infliximab is an accepted induction and maintenance treatment for patients with Crohn's disease. The effectiveness of infliximab has been demonstrated for both active luminal disease and for enterocutaneous fistulisation. In addition, infliximab can be administered for extraintestinal symptoms of Crohn's disease, such as pyoderma gangrenosum, uveitis and arthropathy. Maintenance treatment with infliximab is effective and is regarded as safe as long as the necessary safety measures are heeded. Infusion reactions occur in 3 to 17% of the patients and are associated with the formation of antibodies to infliximab. A reduction in infusion reactions is possible by the concurrent administration of steroids and the use of immunosuppressants (azathioprine, 6-mercaptopurine, methotrexate). Furthermore, immunosuppressants increase the duration of the response to infliximab. For these reasons, the concomitant use of immunosuppressants with infliximab is recommended. Infections and most specifically tuberculosis need to be ruled out before infliximab is administered. Up to now, there are no indications for a connection between an increased risk for malignancies and treatment with infliximab.     

英夫利昔在克罗恩病维持缓解中的应用

克罗恩病(Crohn disease,CD)是一种由于环境、感染、遗传因素等诸多因素综合作用后导致的免疫功能紊乱,最终表现为反复发作的肠道炎症、溃疡和(或)全身症状。英夫利     

Outcome of pregnancy in women receiving infliximab for the treatment of Crohn's disease and rheumatoid arthritis

OBJECTIVES: Infliximab is approved for the treatment of rheumatoid arthritis (RA) and Crohn's disease (CD). We report the first large series of pregnancy outcomes in women with RA and CD exposed to infliximab. METHODS: The infliximab safety database was queried for all reports of pregnancy. Data were extracted regarding the indication for infliximab, timing of infliximab relative to conception, pregnancy course, and pregnancy outcome. The proportion of live births, miscarriages, and therapeutic terminations for women directly exposed to infliximab before or during confirmed pregnancy were compared to those expected for the general U.S. population of pregnant women and pregnant women with CD not exposed to infliximab. RESULTS: Of the 146 identified pregnancies, 131 involved women exposed directly to infliximab and outcome data were available for 96 of these women. Live births occurred in 67% (64/96), miscarriages in 15% (14/96), and therapeutic termination in 19% (18/96) of the pregnancies directly exposed to infliximab with available outcome data. These results are similar to those expected for the general U.S. population of pregnant women or pregnant women with CD not exposed to infliximab. CONCLUSION: Data from the infliximab safety database suggest that infliximab exposure during pregnancy results in outcomes that do not differ from those in the U.S. population of pregnant women and pregnant women with CD not exposed to infliximab. No increased risk of adverse outcome was detected, however, follow-up of larger numbers of pregnant women exposed to infliximab will be necessary to definitively exclude any fetal risk.     

A case of liver nocardiosis associated with Crohn's disease while treating infliximab

A 23-year-old man, complaining of chronic diarrhea, was given a diagnosis of Crohn's disease. He responded well to steroid therapy and infliximab administration. However, high fever appeared on the 28th day of hospitalization, and CT scan revealed multiple liver abscesses. Gram-positive branched rods were harvested by ultrasonography guided puncture examination. As Nocardia infection was suspected, sulfamethoxazole-trimethoprim was started immediately, and his clinical course improved dramatically. Afterwards, Nocardia farcinica was isolated from the culture of the liver abscess. This case is the first report of liver nocardiosis associated with Crohn's disease. Generally, Nocardia infection can be successfully treated by sulfamethoxazole-trimethoprim therapy. Liver nocardiosis is very rare but could be an important complication for patients with Crohn's disease.     

Analysis of adverse effects of infliximab treatment in 486 patients with Crohn's disease

<正>Objective To assess the safety of infliximab(IFX)treatment in patients with Crohn's disease(CD).Methods From January 2009 to May 2018,at inflammatory bowel disease(IBD) center of Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,486 CD     

Severe varicella infection during treatment with infliximab for Crohn's disease

Immunosupressive agents have improved the treatment of severe Crohn's disease. Infliximab is increasingly used in the treatment of Crohn's disease refractory to the usual treatment or with fistulas. However, there is a risk of infection and benign viral infections can became severe. We report the case of a patient treated by azathioprine and infliximab who developed serious chickenpox with multi visceral localisations and transfer to intensive care. There are a few cases of severe varicella infection in the literature with hepatitis and pneumonia in patients treated with infliximab. We review the clinical aspects, therapeutic strategy and prevention of chickenpox in immunodepressed patients.     

Efficacy of early treatment with infliximab in pediatric Crohn’s disease

AIM: To investigate the effectiveness of early infliximab use for induction and maintenance therapy in pediatric Crohn’s disease. METHODS: We performed a retrospective chart review of 36 patients with Crohn’s disease. Ten patients (group A) were treated with mesalamine after induction therapy with oral prednisolone, and 13 patients (group B) were treated with azathioprine after induction therapy with oral prednisolone. Thirteen patients (group C) received infliximab and azathioprine for induction and mainte...     

Short-term study of infliximab treatment for Crohn's disease in China

OBJECTIVE: To determine the effectiveness and safety of short‐term treatment of infliximab (IFX) in a group of Chinese patients with active Crohn's disease (CD). METHODS: Patients with established diagnosis of active CD were treated with IFX intravenously with a dose of 5 mg/kg at week 0, 2, 6. Clinical assessments were performed at baseline (week 0) and every week after IFX infusion until 8 weeks after the induction dose. RESULTS: Fourteen patients (nine male, five female) with a mean age of 29.7 years (range from 15 to 65 years) were included in the analysis. The mean subjective scores were decreased from 2.85 ± 0.57 at baseline to 1.3 ± 0.4 at week 14 (P < 0.05). The mean Harvey‐Bradshaw index was 7.9 ± 1.5 at baseline and 2.3 ± 1.0 at week 14. The levels of erythrocyte sedimentation rate, serum C‐reactive protein, total protein (TP) and albumin (ALB) were significantly improved during the 14‐week period. Colonoscopy showed a remarkable improvement. Mild and transient adverse events including skin itching, headache and elevation of serum alanine aminotransferase and aspartate transaminase were each observed in one patient. Severe anemia, leucopenia and thrombocytopenia at week 27 after three infusions of IFX were observed in one patient. CONCLUSIONS: Treatment with three infusions of IFX at a dose of 5 mg/kg was effective for induction of remission for active CD patients who failed to respond to conventional therapies. Study of long‐term efficacy and safety of IFX therapy is warranted for further investigations.