Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: KEGG:D02598 (Infliximab)
 1,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Infliximab is a monoclonal chimeric antibody, with high affinity and specificity for tumour necrosis factor alpha (TNFalpha) that plays a central role in the pathogenesis of immune mediated inflammatory disorders including Crohn's disease and ulcerative colitis. Globally over 600000 patients have been treated with infliximab to date. This global experience led to a better definition of the overall safety and efficacy profile of this medication. The goal of the present recommendations is to provide practical information to physicians involved in the care of patients with inflammatory bowel disease.
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PMID:[Infliximab--practical guidelines for the treatment of Crohn's disease]. 1692 60

Medical therapy for Crohn disease has advanced incrementally: Small, non-definitive controlled trials of mesalamine continue to be reported, but the results are not sufficient to change the conclusion of a large meta-analysis that shows only marginal benefit of mesalamine in Crohn disease. Low-dose, controlled ileal-release budesonide is not effective for preventing postoperative recurrence of Crohn disease. A loading dose of intravenous azathioprine does not accelerate the time to response in patients with steroid-treated Crohn disease; however, standard azathioprine may work more quickly than previously reported. Mycophenolate mofetil may be therapeutically equivalent to azathioprine for active Crohn disease. There is a trend toward benefit of oral methotrexate (15 mg/wk) for active Crohn disease, and there is no significant difference in the blood concentrations of methotrexate in patients with inflammatory bowel disease who receive methotrexate (15 or 25 mg weekly) administered subcutaneously. Results in a pilot study suggest that tacrolimus may close perianal fistulas in patients with Crohn disease. The anti-tumor necrosis factor antibody infliximab is effective in closing perianal and enterocutaneous fistulas and in maintaining remission in patients with Crohn disease. Infliximab also leads to endoscopic and histologic remission. There is a trend toward benefit of subcutaneous recombinant interleukin-11 for active Crohn disease. Two pilot studies have shown that thalidomide may be of benefit in patients with refractory Crohn disease.
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PMID:Therapy for Crohn disease. 1703 Oct 95

Epidemiologic data suggest that the incidences of pediatric ulcerative colitis and Crohn disease continue to evolve with geographic variations. One study suggests that children with autism have a unique inflammatory bowel disorder that is associated with gastrointestinal symptoms. The appropriate use of new diagnostic tests and novel treatments for inflammatory bowel disease (IBD) needs to be clarified in the pediatric population. Because of concerns regarding sensitivity and specificity, serologic markers measuring anti-Saccharomyces cerevisiae antibodies and perinuclear antineutrophil cytoplasmic antibodies cannot yet replace conventional diagnostic testing for screening or diagnosis of pediatric IBD. Large, prospective, pediatric population-based studies still need to be performed to ascertain their use as a noninvasive screening tool. Genetic studies using thiopurine methyl transferase and measurement of 6-mercaptopurine metabolites appear to be valuable for management of pediatric patients with IBD, in assisting clinicians in optimizing therapeutic response to 6-mercaptopurine, and in identifying individuals at increased risk for drug-induced toxicity. Newer immunomodulatory agents also are being explored in pediatric IBD. Open pilot trials of infliximab (Remicade; Centocor, Malvern, PA) for the treatment of children with Crohn disease that does not respond to conventional management have demonstrated short-term efficacy and safety. Trials of tacrolimus for treatment of fulminant colitis in children have been disappointing.
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PMID:Pediatric inflammatory bowel disease: clinical and therapeutic aspects. 1703 Nov 82

The medical therapy of inflammatory bowel disease (IBD) has advanced significantly over the past year. Serologic markers of IBD have been further investigated and better defined, showing some discriminatory power with potential therapeutic implications. Studies of azathioprine and 6-mercaptopurine metabolites will make it easier and safer to use these effective drugs. Clinical data using other immunomodulators, including 6-thioguanine, mycophenolate mofetil, cyclosporine, and tacrolimus, continue to accrue with positive results. Infliximab has become even more firmly established as a reliable and effective therapy for active and fistulizing Crohn disease and may even be helpful in some patients with resistant ulcerative colitis. However, the recognition of potential complications of infliximab therapy has increased with the accumulated clinical experience. Results from trials of other biologic therapies directed at tumor necrosis factor alpha have been disappointing so far, although preliminary studies with biologics directed at adhesion molecules are encouraging. Growing appreciation of the importance of the enteric microflora in IBD has led to a considerable interest in manipulating intestinal bacteria for therapeutic benefit, and trials of both probiotics and prebiotics show promise.
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PMID:Advances in the medical therapy of inflammatory bowel disease. 1703 18

Current treatment of inflammatory bowel disease is rather effective through it is only working in symptomatic fashion. Most recombinant "biologicals" have not been an overwhelming success. Infliximab has shown clinically relevant efficacy and is used in patients not responding to the standards. Alternatives such as modulating the bacterial-epithelial interaction, tightening of the mucosal barrier and maybe even immunostimulation should be studied since most recent finding on etiology and pathophysiology point to a disturbed barrier with consequent abnormal bacterial epithelial interaction as the main problem in the IBD syndrome. We still need to learn much but we should not focus only on immunosuppressive systems.
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PMID:Inflammatory bowel disease: Pandora's box, present and future. 1705 17

The introduction of infliximab into clinical practice is one of the most significant advances in the care of patients who have IBD. Infliximab has become an important part of the medical armamentarium to treat extraintestinal manifestations that often are refractory to other medications and are a significant cause of morbidity in these patients. Two other TNF inhibitors recently have demonstrated efficacy in CD: certolizumab pegol and adalimumab. The Food and Drug Administration has approved adalimumab for use in RA. One predicts that these agents also may have activity in the extraintestinal manifestation for IBD. To determine whether future biologics are effective in the EIM of IBD, one may need to look no further than the vast clinical trial experience in primary chronic inflammatory diseases of the joints and skin: RA and psoriasis. For example, the Food and DRug Administration recently has approved an anti-B-cell therapy, rituximab, and a T-cell costimulation modulator, abatacept, for use in RA. It certainly will be of interest to determine whether these biologic agents demonstrate efficacy in the intestinal and EIM of IBD.
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PMID:Treatment of immune-mediated extraintestinal manifestations of inflammatory bowel disease with infliximab. 1712 19

Infliximab, the monoclonal anti-tumor necrosis factor-alpha (TNF-alpha) antibodies preparation, is efficacious in the treatment of inflammatory bowel diseases. However, the optimal therapeutic approach is still under investigation. Reports on side effects and potential complications of infliximab therapy, as well as of other anti-TNF-alpha blocking agents are accumulating. Hence, the Israeli Gastroenterological Association had initiated a conference in order to discuss the frequent clinical issues that have arisen following the use of infliximab for the treatment of inflammatory bowel diseases. The aim was to report on the published clinical experience and problems regarding several practical aspects of the use of Infliximab, to suggest guidelines that are evidence-based and to discuss them with experienced IBD-oriented gastroenterologists. The subjects that were discussed include: (1) treatment protocols; (2) maintenance therapy in Crohn's disease; (3) prevention of infections and (4) therapeutic potential in ulcerative colitis. These topics reflect everyday issues that gastroenterologists deal with while treating inflammatory bowel disease patients. The manuscript summarizes the literature and evidence that were presented in the conference, the points raised at the discussions as well as guidelines suggested by work groups that were established for each subject. These guidelines may assist and direct the gastroenterologist treating inflammatory bowel disease patients with infliximab.
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PMID:[Infliximab in inflammatory bowel diseases--conference summary and suggested guidelines]. 1718 61

A 57-year-old man, with a 2-year history of Crohn's disease, presented with a rapidly progressive abdominal ulcer. It was clinically and histologically consistent with pyoderma gangrenosum but it did not respond to either high-dose oral prednisolone or intravenous hydrocortisone. Infliximab resulted in an early, dramatic and sustained improvement. His bowel symptoms, which flared a few weeks prior to the onset of pyoderma gangrenosum, only partially improved. Despite six infliximab infusions, the inflammatory bowel disease is poorly controlled, whereas the pyoderma gangrenosum remains healed.
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PMID:Use of infliximab in pyoderma gangrenosum. 1753 96

Infliximab is arguably the first major advance in therapy for inflammatory bowel disease in more than a quarter of a century. Although it is important to distinguish efficacy from effectiveness, the data from clinical practice mirror those from randomized controlled trials. Infliximab has proven efficacious for luminal manifestations of Crohn's disease (CD) regardless of location. It also has proven efficacy in the subset of penetrating disease to the skin and perianal area, and it increases rates of steroid-free remission. These benefits are reflected in improved quality of life, with limited data showing that infliximab can decrease rates of hospitalization and CD-related surgery. Infliximab also has proven to be efficacious in patients with ulcerative colitis (UC) and has increased rates of steroid-free remission. Whether infliximab will have an impact on the risk of colorectal cancer in UC and Crohn's colitis has yet to be determined. The combination of strong evidence from large randomized controlled trials with substantial examination of use in the practice setting has moved biologic therapy with infliximab from novel to mainstream. In this review, the data for the efficacy of infliximab in controlled trials will be discussed in the context of real world effectiveness.
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PMID:Efficacy of infliximab for luminal and fistulizing Crohn's disease and in ulcerative colitis. 1754 55

Crohn's disease (CD) and ulcerative colitis (UC), collectively referred to as inflammatory bowel disease (IBD), are associated with extraintestinal manifestations (EIMs) in approximately 40% of patients. Infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, is effective for induction and maintenance of remission of CD and UC. The role of infliximab for EIMs related to IBD has been less studied, but it is likely as effective. The EIMs may run a course that parallels IBD activity or may present separately. The EIMs that parallel intestinal inflammation (eg, peripheral arthritis, pyoderma gangrenosum, erythema nodosum, and episcleritis) generally respond to infliximab. Therefore, treating patients with IBD who have one of these EIMs will more often than not improve the EIM. The EIMs that run a separate course from IBD are more difficult to treat. Ankylosing spondylitis (AS), uveitis, and primary sclerosing cholangitis (PSC) have variable responses to IBD medications. Infliximab is efficacious for uveitis and is approved by the US Food and Drug Administration for treatment of AS. The efficacy of infliximab for PSC is unknown. The dosing schedule of infliximab for IBD patients with EIMs should be induction doses with 5 mg/kg at 0, 2, and 6 weeks followed by every 8 weeks. Whether long-term infliximab therapy is necessary to maintain remission of EIMs, as in the case of IBD, has not been established.
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PMID:Efficacy of infliximab for extraintestinal manifestations of inflammatory bowel disease. 1754 56


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