Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 19 November 2017

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Infliximab in steroid dependent Crohn's patients treated with azathioprine or mercaptopurine

Infliximab may be used while waiting for the effect of azathioprine or 6-mercaptopurine in steroid-dependent patients, reported researchers at DDW 2003.

News image

fiogf49gjkf04

In this study, researchers from France assessed whether infliximab, combined with azathioprine (AZA) or 6-mercaptopurine (6MP), could achieve clinical remission without steroids in steroid-dependent Crohn's disease (CD) patients.

Dr Marc Lemann and colleagues selected CD patients with active disease, despite treatment with prednisone (≥10 mg/d) for more than 6 months, for inclusion in the trial.

The research team treated all patients with either AZA (2 to 3 mg/kg/d) or 6MP (1 to 1.5 mg/kg/d).

Patients were divided into 2 strata:

  • Patients who received AZA or 6MP at a stable dose for at least 6 months and still had active disease (CDAI >150) at inclusion (AZA failure).
  • Patients not yet treated with AZA/6MP (naive).

There were 22 centers participating to the trial. From these centers 115 patients (63 female, mean age 30 years) were randomized, 56 to the AZA failure stratum and 59 to the naive stratum.

75% of patients in the infliximab group were in remission at week 12.
American Gastroenterological Association

Within each stratum, the team then randomized patients to receive either 3 infusions of infliximab (5 mg/kg) at day 0, week 2 and week 6, or 3 infusions of placebo.

During the 24 weeks of the study, if a clinical remission was achieved (CDAI <150), then the team tapered the steroids using a standardized scheme. In those patients who experienced a relapse, the team increased the dose of steroids until a new remission was achieved, and then they were tapered again.

The researchers set the primary end-point as remission off steroids at week 24.

The secondary end-points were remission without steroids at week 12, treatment failure due to steroid resistance, and a side-effect steroid score.

Of the 115 patients, 36% had Crohn's disease located in the colon, 14% in the small bowel, and 50% in both. The team found active perianal lesions were present in 22%.

At inclusion, patients had a mean CDAI of 189. The team determined that the median duration of steroid treatment was 15 months, and median dose of prednisone was 30 mg/d.

In stratum 1, median duration of AZA/6MP treatment was 24 months.

Overall, 57 patients were allocated to infliximab and 58 to placebo infusions.

The team found that 75% of patients in the infliximab group were in remission off steroids at week 12, compared with 38% in the placebo group. At week 24, 57% of the infliximab group were in remission off steroids, compared with 29% in the placebo group.

Treatment failure due to steroid resistance was less common in the infliximab group than in the placebo group (5% versus 23%, respectively).

The researchers did not identify any significant difference in infliximab efficacy between the 2 strata.

They determined that the median side-effect steroid score did not differ in the 2 groups at weeks 12 and 24.

The team identified severe adverse events in 2 patients in the infliximab group and in 4 patients in the placebo.

In their conclusion, the researchers suggested that infliximab may be used while waiting for the effect of AZA/6MP in steroid-dependent patients.

This strategy may be effective, even if AZA/6MP has previously failed, to allow steroid withdrawal.

AGA
28 May 2003

Go to top of page Email this page Email this page to a colleague

 17 November 2017 
Food elimination diets for treatment of adults with eosinophilic esophagitis
 17 November 2017 
PPI use and cognitive function in women
 17 November 2017 
Predicting microscopic colitis
 16 November 2017 
NAFLD-hepatocellular carcinoma and survival after orthotopic liver transplant
 16 November 2017 
Prepregnancy obesity and severe maternal morbidity
 16 November 2017 
Celiac disease screening in adult first-degree relatives
 15 November 2017 
Breastfeeding and the risk of IBD
 15 November 2017 
Medication nonadherence and health care costs
 15 November 2017 
Predicting recurrence after curative rectal cancer surgery
 14 November 2017 
HBV/HCV coinfection and cirrhosis
 14 November 2017 
Sexual dysfunction after rectal cancer surgery
 14 November 2017 
Eosinophilic gastroenteritis and colitis
 13 November 2017 
GI bleeding in patients taking non–vitamin K antagonist oral anticoagulants
 13 November 2017 
Genetic polymorphisms, fatty acids and ulcerative colitis
 13 November 2017 
Flares after immunomodulator withdrawal in Crohn's
 10 November 2017 
Thiopurines vs TNF and lymphoma risk in IBD
 10 November 2017 
Drug monitoring of anti-tumour necrosis factor therapy in IBD
 10 November 2017 
Treatment decisions for older patients with colorectal cancer
 09 November 2017 
Quality standards in upper gastrointestinal endoscopy
 09 November 2017 
Irradiated rectal cancer and chemoradiotherapy
 09 November 2017 
Environmental factors and IBD
 08 November 2017 
Prophylaxis of spontaneous bacterial peritonitis
 08 November 2017 
Socioeconomic characteristics in diverticular disease
 08 November 2017 
Optimal management of postoperative Crohn's disease
 07 November 2017 
Community Screening for Helicobacter pylori
 07 November 2017 
Early readmission in IBD patients
 07 November 2017 
Mesocolic excision for colon cancer
 06 November 2017 
Food elimination diet for children with eosinophilic esophagitis
 06 November 2017 
Biologic agents and obesity in children with IBD
 06 November 2017 
Liver cancer burden despite extensive use of antiviral agents
 03 November 2017 
Statins and mortality in chronic viral hepatitis
 03 November 2017 
Propofol for outpatient colonoscopy
 03 November 2017 
Asthma and IBD development
 02 November 2017 
Diverticulitis and emergency department burden
 02 November 2017 
Rural residence and risk of IBD
 02 November 2017 
Sexual functioning in Hep C
 01 November 2017 
Heartburn relief in adolescents with GERD
 01 November 2017 
Barriers to hepatitis C treatment
 01 November 2017 
Autoimmune pancreatitis in children
 31 October 2017 
Surveillance in ulcerative colitis and Crohn’s disease
 31 October 2017 
Endoscopic indices of disease activity for Crohn’s
 31 October 2017 
Follow-up of positive results on fecal blood tests
 30 October 2017 
Local recurrence after curative rectal cancer surgery
 30 October 2017 
Low-flow ascites pump in refractory cirrhosis
 30 October 2017 
Medical therapy of patients with pediatric-onset IBD
 27 October 2017 
NAFLD in advanced fibrosis in the USA
 27 October 2017 
Early readmission in cirrhosis after bacterial infections
 26 October 2017 
Predicting response to anti-TNF therapy in Crohn's
 26 October 2017 
Conversion to open laparotomy in rectal cancer
 25 October 2017 
Conversion of colonoscopy to sigmoidoscopy
 25 October 2017 
Fecal microbiota transplantation
 25 October 2017 
Rifaximin and survival in hepatic encephalopathy
 24 October 2017 
Eosinophilic esophagitis with swallowed topical corticosteroids
 24 October 2017 
Meta-analysis in nutritiona research
 23 October 2017 
NAFLD-related hepatocellular carcinoma in liver resection
 23 October 2017 
Outcome of hepatic sarcoidosis
 20 October 2017 
Hospital readmissions reduction program
 20 October 2017 
Conversion of planned colonoscopy to sigmoidoscopy
 19 October 2017 
Fecal immunochemical tests in colorectal cancer screening
 19 October 2017 
Current management of chylous ascites

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2017 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us