Long term treatment with infliximab in non-fistulising Crohn's disease

Infliximab, a chimeric monoclonal IgG1 antibody to TNF is the first biological therapy approved for Crohn's disease and is efficacious in patients with luminal Crohn's disease refractory or intolerant to standard treatment with glucocorticosteroids and/or immunomodulators. The optimal strategy is induction therapy with infliximab 5 mg/kg IV at weeks 0-2-6 followed by systematic maintenance treatment every 8 weeks. Infliximab induces rapid endoscopic and histologic healing. Long-term maintenance therapy with infliximab results in a reduction of the rate of complications, hospitalisations and surgeries associated with Crohn's disease. The response to infliximab may be optimized by concomitant immunosuppressive therapy. Safety problems mainly concern immunogenicity due to the formation of antibodies to infliximab (ATI) which may lead to infusion reactions, loss of response and serum sickness-like delayed infusion reactions. Actions to reduce immunogenicity include systematic maintenance therapy, concomitant use of immunomodulators and pre-treatment with corticosteroids. Latent tuberculosis needs to be screened for before onset of therapy. The rate of other opportunistic infections is slightly increased mainly in patients treated concomitantly with immunomodulators. Malignancy rates in patients treated with anti-TNF strategies are not increased.