Journal ArticleDOI
Infliximab, Azathioprine, or Combination Therapy for Crohn's Disease
Jean-Frederic Colombel,William J. Sandborn,Walter Reinisch,Gerassimos J. Mantzaris,Asher Kornbluth,Daniel Rachmilewitz,Simon Lichtiger,Robert H. Diamond,Delma L. Broussard,Kezhen L. Tang,C. Janneke van der Woude,Paul Rutgeerts +11 more
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TLDR
Patients with moderate-to-severe Crohn's disease who were treated with infliximab plus azathioprine or inflIXimab monotherapy were more likely to have a corticosteroid-free clinical remission than those receiving azATHioprine monotherapy.Abstract:
In this randomized, double-blind trial, we evaluated the efficacy of infliximab monotherapy, azathioprine monotherapy, and the two drugs combined in 508 adults with moderate-to-severe Crohn’s disease who had not undergone previous immunosuppressive or biologic therapy. Patients were randomly assigned to receive an intravenous infusion of 5 mg of infliximab per kilogram of body weight at weeks 0, 2, and 6 and then every 8 weeks plus daily oral placebo capsules; 2.5 mg of oral azathioprine per kilogram daily plus a placebo infusion on the standard schedule; or combination therapy with the two drugs. Patients received study medication through week 30 and could continue in a blinded study extension through week 50. Results Of the 169 patients receiving combination therapy, 96 (56.8%) were in corticosteroid-free clinical remission at week 26 (the primary end point), as compared with 75 of 169 patients (44.4%) receiving infliximab alone (P = 0.02) and 51 of 170 patients (30.0%) receiving azathioprine alone (P<0.001 for the comparison with combination therapy and P = 0.006 for the comparison with infliximab). Similar numerical trends were found at week 50. At week 26, mucosal healing had occurred in 47 of 107 patients (43.9%) receiving combination therapy, as compared with 28 of 93 patients (30.1%) receiving infliximab (P = 0.06) and 18 of 109 patients (16.5%) receiving azathioprine (P<0.001 for the comparison with combination therapy and P = 0.02 for the comparison with infliximab). Serious infections developed in 3.9% of patients in the combination-therapy group, 4.9% of those in the infliximab group, and 5.6% of those in the azathioprine group. Conclusions Patients with moderate-to-severe Crohn’s disease who were treated with infliximab plus azathioprine or infliximab monotherapy were more likely to have a corticosteroid-free clinical remission than those receiving azathioprine monotherapy. (ClinicalTrials.gov number, NCT00094458.)read more
Citations
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Journal ArticleDOI
Crohn's disease
TL;DR: The epidemiology, immunobiology, amd natural history of Crohn's disease is discussed; new treatment goals and risk stratification of patients are described; and an evidence based rational approach to diagnosis is provided.
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Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE): Determining Therapeutic Goals for Treat-to-Target.
Laurent Peyrin-Biroulet,William J. Sandborn,Bruce E. Sands,Walter Reinisch,Walter Reinisch,Willem A. Bemelman,Robert V Bryant,G R D’Haens,Iris Dotan,Marla Dubinsky,Brian G. Feagan,Gionata Fiorino,Richard B. Gearry,S. Krishnareddy,Peter L. Lakatos,Edward V. Loftus,P. Marteau,Pia Munkholm,Travis B. Murdoch,Ingrid Ordás,Remo Panaccione,Robert H. Riddell,J. Ruel,David T. Rubin,Mark A Samaan,Corey A. Siegel,Mark S. Silverberg,Jaap Stoker,Stefan Schreiber,Simon Travis,G. Van Assche,G. Van Assche,Silvio Danese,Julián Panés,Guillaume Bouguen,Sarah O’Donnell,Benjamin Pariente,S. Winer,Stephen B. Hanauer,J.-F. Colombel +39 more
TL;DR: Evidence- and consensus-based recommendations for selecting the goals for treat-to-target strategies in patients with IBD are made available and future studies are needed to determine how these targets will change disease course and patients’ quality of life.
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Second European evidence-based consensus on the diagnosis and management of ulcerative colitis Part 2: Current management
Axel Dignass,James O. Lindsay,Andreas Sturm,Alastair Windsor,Jean-Frederic Colombel,Mathieu Allez,G. D'Haens,André D'Hoore,Gerassimos J. Mantzaris,Gottfried Novacek,Tom Øresland,Walter Reinisch,Miquel Sans,Eduard F. Stange,Severine Vermeire,Simon Travis,Gert Van Assche +16 more
TL;DR: The most widely used index for severe UC remains that of Truelove and Witts3: any patient who has a bloody stool frequency ≥ 6/day and a tachycardia (> 90 bpm), or temperature > 37.8 °C, or anaemia (haemoglobin 30 mm/h) has severe ulcerative colitis (Table 1.3) as mentioned in this paper.
Journal ArticleDOI
Crohn's disease
TL;DR: An physician-oriented overview of Crohn's disease in adults is provided, ranging from epidemiology and cause to clinical diagnosis, natural history, patient stratification and clinical management, and ending with an overview of emerging therapies and future directions for research.
Journal ArticleDOI
Guidelines for the management of inflammatory bowel disease in adults
Craig Mowat,Andrew Cole,Al Windsor,Tariq Ahmad,Ian D. Arnott,R Driscoll,Sally G. Mitton,Timothy R. Orchard,Matthew D. Rutter,Lisa Younge,Charlie W. Lees,Gwo-Tzer Ho,Jack Satsangi,Stuart Bloom +13 more
TL;DR: The present document is intended primarily for the use of clinicians in the United Kingdom, and serves to replace the previous BSG guidelines in IBD, while complementing recent consensus statements published by the European Crohn's and Colitis Organisation (ECCO).
References
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Journal ArticleDOI
Maintenance infliximab for Crohn's disease: the ACCENT I randomised trial
Stephen B. Hanauer,Brian G. Feagan,Gary R. Lichtenstein,Lloyd Mayer,Stefan Schreiber,Jean-Frederic Colombel,Daniel Rachmilewitz,Douglas C. Wolf,Allan Olson,Weihang Bao,Paul Rutgeerts +10 more
TL;DR: Patients with Crohn's disease who respond to an initial dose of infliximab are more likely to be in remission at weeks 30 and 54, to discontinue corticosteroids, and to maintain their response for a longer period of time, if inflIXimab treatment is maintained every 8 weeks.
Journal ArticleDOI
Development of a Crohn's Disease Activity Index: National Cooperative Crohn's Disease Study
TL;DR: In this paper, a multiple regression computer program was utilized to derive an equation for prediction of the physician's over-all ratings from a subset of the predictor variables fulfilling a combination of constraints.
Journal ArticleDOI
A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn's disease. Crohn's Disease cA2 Study Group.
Stephan R. Targan,Stephen B. Hanauer,S. J. H. Van Deventer,Lloyd Mayer,Daniel H. Present,T. Braakman,K. L. Dewoody,T. F. Schaible,Paul Rutgeerts +8 more
TL;DR: A 12-week multicenter, double-blind, placebo-controlled trial of cA2 in 108 patients with moderate-to-severe Crohn's disease that was resistant to treatment, finding clinical response, the primary end point, was a reduction of 70 or more points in the score on theCrohn's Disease Activity Index at four weeks.
Journal ArticleDOI
The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Current management
Axel Dignass,G. Van Assche,James O. Lindsay,Marc Lémann,Johan D. Söderholm,Jean-Frederic Colombel,Silvio Danese,André D'Hoore,Miquel A. Gassull,Fernando Gomollón,Daan W. Hommes,Pierre Michetti,Colm O'Morain,Tom Øresland,Alastair Windsor,Eduard F. Stange,Simon Travis +16 more
TL;DR: This paper is the second in a series of three publications relating to the European evidence-based consensus on the diagnosis and management of Crohn's disease and concerns the management of active disease, maintenance of medically induced remission and surgery.
Journal ArticleDOI
Long-term evolution of disease behavior of Crohn's disease.
Jacques Cosnes,Stéphane Cattan,Antoine Blain,Laurent Beaugerie,Franck Carbonnel,Rolland Parc,Jean-Pierre Gendre +6 more
TL;DR: Most patients with CD will eventually one day develop a stricturing or a perforating complication, and initial location determines the type of the complication.
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