Infliximab for Crohn's disease in the Swiss IBD Cohort Study: clinical management and appropriateness.

Abstract

OBJECTIVE:

Antitumor necrosis factor a agents have significantly improved the management of Crohn's disease (CD), but not all patients benefit from this therapy. We used data from the Swiss Inflammatory Bowel Disease Cohort Study and predefined appropriateness criteria to examine the appropriateness of use of infliximab (IFX) in CD patients.

METHODS:

EPACT II (European Panel on the Appropriateness of CD Therapy, 2007; www.epact.ch) appropriateness criteria have been developed using a formal explicit panel process combining evidence from the published literature and expert opinion. Questionnaires relating to EPACT II criteria were used at enrollment and follow-up of all Swiss Inflammatory Bowel Disease Cohort Study patients. A step-by-step analysis of all possible indications for IFX therapy in a given patient allowed identification of the most appropriate indication and final classification in a single appropriateness category (appropriate, uncertain, inappropriate).

RESULTS:

Eight hundred and twenty-one CD patients were prospectively enrolled between November 2006 and March 2009. IFX was administered to 146 patients (18%) at enrollment and was most frequently used for complex fistulizing disease and for the maintenance of remission induced by biological therapy. IFX therapy was considered appropriate in 44%, uncertain in 44%, and inappropriate in 10% of patients.

CONCLUSION:

In this cohort, 9 out of 10 indications for IFX therapy were clinically generally acceptable (appropriate or uncertain) according to EPACT II criteria. Uncertain indications resulted mainly from the current more liberal use of IFX in clinical practice as compared with the EPACT II criteria.

• Authors: Pascal Juillerat, Valérie Pittet, John-Paul Vader, Bernard Burnand, Jean-Jacques Gonvers, Philippe de Saussure, Christian Mottet, Frank Seibold, Gerhard Rogler, Markus Sagmeister, Christian Felley, Pierre Michetti, Florian Froehlich, Swiss IBD Cohort Study Group
• Journal: European journal of gastroenterology & hepatology (Eur J Gastroenterol Hepatol) Vol. 22 Issue 11 Pg. 1352-7 (Nov 2010) ISSN: 1473-5687 [Electronic] England
• PMID: 20964261 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Inflammatory Agents
• Antibodies, Monoclonal
• Gastrointestinal Agents
• Infliximab

Topics

• Adolescent
• Adult
• Anti-Inflammatory Agents (therapeutic use)
• Antibodies, Monoclonal (therapeutic use)
• Crohn Disease (diagnosis, drug therapy)
• Female
• Gastrointestinal Agents (therapeutic use)
• Guideline Adherence
• Humans
• Infliximab
• Male
• Patient Selection
• Practice Guidelines as Topic
• Predictive Value of Tests
• Prospective Studies
• Severity of Illness Index
• Switzerland
• Treatment Outcome
• Young Adult