Efficacy on Remission and Maintenance Therapy

Infliximab, administrated intravenously at a dosage of 5 mg/kg of body weight at weeks 0, 2 and 6 (induction therapy) and, later, every 8 weeks (maintenance therapy) is effective in the therapy of patients with active CD [12]. Infliximab is also a corticosteroid-sparing drug in patients with active CD [13-15]. Definite indications for induction therapy with infliximab (eligible patients) are [13]: (1) Fibrostenosing (inflammatory) disease nonrespondent or refractory to steroid and conventional therapy; (2) fistulising disease, draining enterocutaneous or perianal fistu-lae.

The use of infliximab as first-line treatment of patients with moderate to severe CD is still controversial. There are no studies demonstrating the efficacy of this scheduled therapy even though this approach has been suggested [16].

Table 1. Bblogical therapy in Crohn's disease

Proper name

Trade name

Action

Inhibitors of pro-inflammatory cytokines

CDP571 Certolizumab

Adalimumab Thalidomide

Semapimod Etanercept

Onercept MRA

Humira Thalomid

Enbrel

Chimeric (human/mouse) anti-TN- a monoclonal antibody (IgG1)

Humanized anti-TN a monoclonal antibody (IgG4) Humanized anti-TN- a monoclonal antibody (polyethylene glycolated Fab' fragment)

Humanized anti-TN- a monoclonal antibody (IgG1) Derivative of glutamic acid with anti-inflammatory and anti-TFN- a action

Interferes with the phosphorylation of both p38 and N Genetically engineered fusion protein consisting of two identical chains of the recombinant human p75 TN receptor linked to the Fc portion of human IgG1 Recombinant form of the human soluble p55 TNreceptor Humanized monoclonal antibody to II6 receptor Humanized anti-II12 p40 (IgG 1)

Anti-inflammatory cytokines

RhIL10 RhIL11

Tenovil

Humanized monoclonal antibody to II10 Humanized monoclonal antibody to II11

Inhibitors of adhesion molecules

Alicaforsen Malizumab

Antegren

Antisense phosphorothioate oligonucleotide targeting human ICAM-1 mRN

Humanized monoclonal antibody against a4 integrin

Immune modulators

Mycophenolate mofetil

Prograf CellCept

Inhibits production of IL 2 by T-helper cells Antimetabolite strongly suppressing lymphocyte proliferation

Miscellaneous

Sargramostim Trichuris suis Probiotics

tukine St

Yast-derived recombinant human GM-CSF

Worm

8cteria

TNF, tumor necrosis factor; IgG, immunoglobulin G;JNK, Jin Nerminal kinase; ICAM, intercellular adhesion molecule; mRNA, messenger ribonucleic acid; IL, interleukin;GM-CSF, granulocyte macrophage colony stimulating factor

TNF, tumor necrosis factor; IgG, immunoglobulin G;JNK, Jin Nerminal kinase; ICAM, intercellular adhesion molecule; mRNA, messenger ribonucleic acid; IL, interleukin;GM-CSF, granulocyte macrophage colony stimulating factor

Induction therapy is effective in up to 70% of cases [10, 12, 17-30]. Nt responders to induction therapy do not respond to a maintenance therapy. In patients who respond to induction therapy, maintenance therapy may prolong complete clinical remission [Crohn's Disease Activity Index (CDAI) <150] after 1 year in about 40% of cases, with clinical response in 60% of cases. This implies that, after 1 year of prolonged infliximab therapy, only 25% of patients attain complete clinical remission and 35% clinical response [10, 12, 17-29]. There is evidence that an increase of infliximab dosage and/or a reduction of interval time between infusions may main tain a higher number of patients in clinical remission [21, 31-33].

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