Infliximab in Crohn's disease and ulcerative (UC) colitis

• infusion of infliximab will induce endoscopic and clinical remission in the 60% of patients with Crohn's disease that is unresponsive to azathioprine and steroids (1). In patients with fistulising or treatment-resistant Crohn's disease, infliximab increases remission rates and response rates (2)
• major limitations to the use of infliximab include the intravenous route of administration of the drug and expense (3)
• in February 2001, the Committee on Safety of Medicines reported that there had been 28 spontaneous reports of the onset or re-activation of tuberculosis suspected to be a reaction to infliximab therapy (4)
• NICE have produced guidance on the clinical situations when the use of infliximab is appropriate in Crohn's disease (see linked page)
• a systematic review concerning the use of infliximab in ulcerative colitis has been undertaken (5):
  • the review concluded that infliximab was more effective than placebo, with an NNT from 3 to 5, for the treatment of moderate-to-severe UC, that achieved clinical remission in 40% of the patients at approximately 9 months of follow-up
• NICE have stated that (6):
  • infliximab, adalimumab and golimumab are recommended as options for treating moderately to severely active ulcerative colitis in adults whose disease has responded inadequately to conventional therapy including corticosteroids and mercaptopurine or azathioprine, or who cannot tolerate, or have medical contraindications for, such therapies
    
    
  • infliximab is recommended as an option for treating severely active ulcerative colitis in children and young people aged 6-17 years whose disease has responded inadequately to conventional therapy including corticosteroids and mercaptopurine or azathioprine, or who cannot tolerate, or have medical contraindications for, such therapies
    
    
  • infliximab, adalimumab or golimumab should be given as a planned course of treatment until treatment fails (including the need for surgery) or until 12 months after starting treatment, whichever is shorter
    • should continue treatment only if there is clear evidence of response as determined by clinical symptoms, biological markers and investigation, including endoscopy if necessary
    • should consider a trial withdrawal from treatment for all patients who are in stable clinical remission. People whose disease relapses after treatment is stopped should have the option to start treatment again

Reference:

• (1) Targan SR et al (1997). A short-term study of chimeric monoclonal antibody cA2 to tumour necrosis factor alpha for Crohn's disease. NEJM, 337, 1029-35.
• (2) ACP J Club 2002 Nov-Dec;137(3):91
• (3) Prescriber (2001), 12 (20), 43-58.
• (4) Committee on Safety of Medicines (2001), Current Problems in Pharmacovigilance, 27, 1-8.
• (5) Gisbert JP et al. Systematic review: Infliximab therapy in ulcerative colitis. Aliment Pharmacol Ther. 2007 Jan 1;25(1):19-37
• (6) NICE (February 2015). Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy (including a review of TA140 and TA262)