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Use of TNF Inhibitors in Crohn's Disease Discussed

Recommended for patients with severe, moderate dz with active inflammation despite standard tx
WEDNESDAY, Aug. 21 (HealthDay News) -- For patients with Crohn's disease with active inflammation despite receiving standard treatment, tumor necrosis factor (TNF) inhibitors are recommended, according to a case vignette published in the Aug. 22 issue of the New England Journal of Medicine.
Ole Haagen Nielsen, M.D., D.M.Sc., and Mark Andrew Ainsworth, M.D., Ph.D., D.M.Sc., from Herlev Hospital in Denmark, presented a therapeutic recommendation for a 35-year old male patient with an exacerbation of Crohn's ileocolitis. The patient was treated on three occasions during eight years with prednisone, and started azathioprine one year prior to presentation. The patient presented with abdominal pain in the right lower quadrant and an increase in stool frequency. After identifying acute and chronic granulomatous inflammation, the gastroenterologist recommended TNF inhibitor treatment.
Based on clinical evidence, the authors note that TNF inhibitors are efficacious for Crohn's disease, as first-line therapy and for patients with inadequate responses to standard therapy. They can reduce disease symptoms and promote healing. Direct evidence is lacking for the relative efficacy and safety of TNF inhibitors. Because they interfere with normal inflammatory response, TNF inhibitors should not be used for patients with uncontrolled infections, and patients should be monitored for infection during treatment. Current U.S. and European guidelines recommend TNF-α monoclonal antibodies for patients with moderate-to-severe disease with an inadequate response to a glucocorticoid or immunomodulator, and as an alternative to glucocorticoids for selected patients with Crohn's disease.
"The patient described in the vignette is a candidate for TNF-inhibitor treatment because he has active inflammation (documented by magnetic resonance enterography, endoscopy, histologic findings, and an elevated C-reactive protein level) despite having received standard treatment for Crohn's disease," the authors write.
Full Text (subscription or payment may be required) (http://www.nejm.org/doi/full/10.1056/NEJMct1209614 )
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