Efficacy of TNF Antagonists Beyond One Year in Adult and Pediatric Inflammatory Bowel Diseases: A Systematic Review

Abstract

The introduction in the mid-1990s of tumor necrosis factor (TNF) antagonists changed the treatment of inflammatory bowel diseases (IBD), Crohn's disease and ulcerative colitis (UC) refractory to conventional medications (corticosteroids, immunomodulators). This review summarizes current data on the long-term efficacy and safety of anti-TNF therapy in IBD beyond 1 year. We searched Medline, the Cochrane Library, Embase, and Ovid Medliner for relevant studies. Infliximab, adalimumab and certolizumab are effective in maintaining clinical remission in luminal Crohn's disease. Infliximab and adalimumab are also effective in maintaining long-term fistula closure in Crohn's disease. Only infliximab has been evaluated in UC in the long term, with similar data on its effectiveness than in CD. In addition to the maintenance of clinical remission, TNF antagonists have the ability to maintain long-term mucosal healing, resulting in a reduced risk of surgery. With 2010 on the horizon, we have no good reasons to stop anti-TNF therapy in IBD patients because of its efficacy in maintaining remission and a risk-benefit ratio that remains in its favor. It is now clear that patients in deep remission, comprising clinical, biological, and endoscopic remission, are at lower risk of relapse after withdrawal of anti-TNF therapy.

Influence of extra virgin olive oil diet enriched with hydroxytyrosol in a chronic DSS colitis model

“…After 3 weeks of DSS removal, EVOO diets reduced significantly both COX-2 and iNOS expression versus standard diet, where these proteins were appreciably increased compared to sham group. These results are also consistent with other experimental models where, for example, olive oil inhibited COX-2 immunostaining in IL-10 knockout mice [27], endogenously synthesized n-3 PUFAs downregulated COX-2 expression in DSS-induced colitis in fat-1 mice [31] or n-3 PUFA-rich diet showed beneficial effect via inhibition of COX-2 and iNOS expression, among other inflammatory parameters, in TNBS-induced colitic rats [32].…”

“…Cytokines, such as IL-1 and TNF-a, share a multitude of pro-inflammatory properties and are crucial in the amplification of mucosal inflammation in IBD [1,2]. In the last years, TNF-a has been the target of clinical investigations aimed at blocking its activity as a novel form of therapy for UC [27]. Our data showed that in DSS groups fed with EVOO diets, TNF-a values were maintained near to sham controls, which is in line with the aforementioned previous reports, where blocking TNF-a can inhibit the pro-inflammatory response.…”

Clinical Efficacy of Infliximab in Moderate to Severe Ulcerative Colitis in a Latin American Referral Population

“…A recent systematic review of the literature found that colectomy rates in UC patients receiving IFX treatment ranged from 17 to 53% [20]. …”

THERAPIES FOR CROHN'S DISEASE: a clinical update

“…It is in these situations especially that biological therapy is applied. It is indicated both for inducing remission during periods of exacerbation of the disease, and for maintaining clinical and endoscopic remission, with or without associated use of other drug classes (14,20,22,24,34,35,(38)(39)(40)43,51) . Initially, severe penetrating perianal disease was the main form of CD with an indication for biological therapy.…”

“…However, in selected cases of patients with clinical and endoscopic remission for more than two years, the treatment may be discontinued after patient compliance (34) . Monitoring of adverse effects and the possible complications arising from the use of immunosuppressants and biological therapy is extremely important, especially with the aim of avoiding opportunistic infections or even enabling early diagnosis and appropriate treatment.…”