Crohn's disease and ulcerative colitis are excellent examples on how the exponential growth of knowledge in biomedical science can make a remarkable impact on clinical practice and patient's quality of life. Recent advances have led to new therapeutic concepts targeting almost every aspect of the inflammatory process and help with the restitution of mucosal integrity.
This book summarizes conventional therapy and explores all approved biologic therapies. All medications in their respective indications for children and adults are discussed by an international panel of experts. A specific chapter was dedicated to therapy-associated risks of biologic therapy and effective strategies to prevent and manage complications. To address the needs associated with family planning, one chapter explores the impact of biologic therapy on fertility, pregnancy and nursing.
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978-3-8374-5252-5 (9783837452525)
Schweitzer Klassifikation
1. Conventional Therapy of Inflammatory Bowel Disease 12
1.1. 5-Aminosalicylic acid (5-ASA) 12
1.2. Corticosteroids 12
1.3. Budesonide 13
1.4. Antibiotics 14
1.5. Azathioprine/6-Mercaptopurine (6-MP) 14
1.6. Methotrexate 14
1.7. Cyclosporine 15
1.8. Tacrolimus (FK506) 15
1.9. Surgical options 15
2. Biologic Therapy of Inflammatory Bowel Disease 18
2.1. Anti-TNF therapy for luminal Crohn's disease 18
2.1.1. Infliximab 18
2.1.1.1. Pooled evidence for efficacy to maintain remission 19
2.1.1.2. Optimal long-term treatment schedules 19
2.1.1.3. Can anti-TNF therapy ever be stopped? 19
2.1.2. Adalimumab 21
2.1.2.1. Pharmacodynamics 21
2.1.2.2. Pharmacokinetics 22
2.1.2.3. Clinical efficacy 22
2.1.2.4. CLASSIC 1 22
2.1.2.5. CLASSIC 2 23
2.1.2.6. CHARM 23
2.1.2.7. GAIN 26
2.1.2.8. Other studies 27
2.1.3. Certolizumab 29
2.1.3.1. Efficacy of certolizumab pegol in Crohn's disease 29
2.1.3.2. Safety of certolizumab pegol 31
2.2. Anti-TNF therapy for fistulizing Crohn's disease 32
2.2.1. Infliximab 32
2.2.1.1. Treatment of fistulas with infliximab 32
2.2.2. Adalimumab 35
2.2.2.1. Data from CHARM 35
2.2.2.2. Other studies 36
2.3. Anti-TNF Therapy for ulcerative colitis 37
2.3.1. Infliximab 37
2.3.1.1. The early non-controlled experience with infliximab 37
2.3.1.2. Randomized controlled trials with infliximab 37
2.3.1.3. Standard-treatment controlled trials with infliximab 39
2.3.1.4. Cochrane meta-analysis on infliximab for induction of remission in ulcerative colitis 39
2.3.1.5. Open-label experiences 39
2.3.1.6. Consensus guidelines 40
2.4. Anti-adhesion molecule therapy for Crohn's disease and ulcerative colitis 41
2.4.1. Leukocyte-endothelial cell interactions 41
2.4.2. Adhesion molecules involved in leukocyte-endothelial cell interactions 42
2.4.3. Adhesion molecules in human IBD 45
2.4.4. Adhesion molecules as targets for therapeutic intervention 46
2.4.5. Natalizumab 49
2.4.6. Blockade of a4b7 - MAdCAM-1 interactions 52
3. Fertility, Pregnancy and Nursing and Biologic Therapy 58
3.1. Fertility 58
3.2. Safety of biologics during pregnancy 58
3.3. Anti-TNFa therapies 59
3.3.1. Breastfeeding and anti-TNFa 60
3.3.2. The effects of in utero exposure to anti-TNFa 61
4. Risks and Complications of Biologic Therapy 64
4.1. Where do risk data come from? 64
4.2. Risks of anti-TNF agents 64
4.2.1. Infections 65
4.2.2. Demyelinating disorders 66
4.2.3. Heart failure 66
4.2.4. Antibody formation 66
4.2.5. Anti-TNFs and cancer 67
4.3. Is combination therapy more risky? 68
4.4. Natalizumab 68
5. Pediatric Aspects of Biologic Therapy 74
5.1. Efficacy of biologic agents in pediatric patients 74
5.2. Biologic therapy and growth 75
5.3. Safety concerns for pediatric patients 75
Index 78
