Crohn's disease (CD) and ulcerative colitis (UC) are chronic-relapsing diseases, the clinical courses of which are characterized by periods of remission and periods of acute flare up, determining clinical symptoms which have a strong impact on the quality of life for patients. For many years, corticosteroids have represented the cornerstone of therapy for induction of remission in Inflammatory Bowel Disease (IBD); however, the side-effects emerging with long-term use exceeded the clinical benefits. Recently, Infliximab (IFX) has become an alternative choice in the treatment strategies for CD and UC. Some safety issues are associated with IFX use, mostly related to the development of adverse events (e.g. opportunistic infections, autoimmune disorders and infusion reactions). Major concerns are related to the reactivation of latent tuberculosis and development of malignancy, even if there is no clear evidence the use of IFX increases the incidence of solid cancers. The research published on issue 39 of World Journal of Gastroenterology and led by Renato Caviglia at University Campus Biomedico in Italy aimed to retrospectively evaluate the safety and efficacy of long-term therapy with IFX, reviewing the medical charts of 41 IBD patients who received, after a loading dose of 3 IFX infusions, scheduled retreatment every 8 weeks as maintenance protocol.
Results of this retrospective study confirm current data on the efficacy of IFX in inducing a rapid clinical response in CD and UC, and support the finding, emerging from uncontrolled study data, of prolonged clinical efficacy in maintaining long-lasting remission beyond 1 year of treatment. The steroid-sparing effect of IFX was another important finding emerging from our study, which confirmed the efficacy of a scheduled treatment regimen in avoiding the well-known morbidity associated with long-term corticosteroid therapy. Interestingly, long-term IFX therapy in IBD has been demonstrated to potentially modify the course of the disease. Indeed, 9 out of the 29 CD and 4 out of the 9 UC patients, who discontinued IFX scheduled treatment, were still relapse-free after a median of 16 (range, 5-30) and 6.5 (range, 4-16) months since the last IFX infusion, respectively.
A note of caution is mandatory when considering the possible risk of malignancy associated with the use of anti-TNF-alpha therapy. Further studies on larger scales are needed to further clarify these important aspects.
Reference: Caviglia R, Ribolsi M, Rizzi M, Emerenziani S, Annunziata ML, Cicala M. Maintenance of remission with infl iximab ininfl ammatory bowel disease: Effi cacy and safety long-termfollow-up. World J Gastroenterol 2007; 13(39): 5238-5244
Correspondence to: Renato Caviglia, MD, PhD, University Campus Biomedico, Department of Digestive Disease, Via E. Longoni, Rome 83, 00155, Italy. firstname.lastname@example.org
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World Journal of Gastroenterology (World J Gastroenterol, WJG), a leading international journal in gastroenterology and hepatology, has an established reputation for publishing fi rst class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection, providing a forum for both clinicians and scientists, and has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by The WJG Press. The publication date is 7th, 14th, 21st, and 28th every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No.30424812, which was founded with a name of China National Journal of New Gastroenterology on October 1, 1995, and renamed as WJG on January 25, 1998.
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