Biologic therapy in inflammatory bowel disease

Klaus Theede, Jens Frederik Dahlerup, Jan Fallingborg, Christian Lodberg Hvas, Jens Kjeldsen, Lars Kristian Munck, Inge Nordgaard-Lassen

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

In luminal Crohn's disease with moderate to severe inflammatory activity, infliximab and adalimumab can be used in the case of treatment failure with conventional therapies, such as systemic steroids and immunosuppressive therapy or if this treatment is not tolerated. Further treatment strategy depends on the primary response to induction therapy. Effect of maintenance therapy should be evaluated clinically and paraclinically at least every 26-52 weeks, and maybe supplemented by endoscopy or MRI scan. Decision of treatment discontinuation is based on disease manifestation, treatment response and paraclinical parameters. In fistulising Crohn's disease, treatment with infliximab or adalimumab can be initiated in simple fistula with rectal inflammation or complex fistula when the initial treatment has insufficient effect. Further treatment strategy depends on the primary response to induction therapy. Maintenance therapy is often necessary in complex fistulas. Treatment efficacy and possible discontinuation of treatment is evaluated at least every 26-52 weeks - if possibly with diagnostic imaging. In acute severe ulcerative colitis, treatment with infliximab can be used in patients with partial response after 3-5 days of treatment with a high-dose systemic steroid and when surgical treatment is not preferred or required. Further treatment strategy depends on the response to the first drug administration and colectomy should always be considered as an option. Effect of subsequent initiated maintenance therapy should be evaluated at least every 26-52 weeks on the basis of symptoms, clinical markers, paraclinical parameters and possibly by endoscopy. In chronic active ulcerative colitis, infliximab and adalimumab can be used in the case of treatment with immunosuppressive therapy fails and if surgery is not preferred. Further treatment strategy depends on the response to induction therapy. Treatment efficacy is assessed by symptoms, clinical markers, paraclinical parameters and possibly by endoscopy. Effect of maintenance therapy should be evaluated at least every 26-52 weeks. During treatment with biologic drugs focus should be on possible complications, such as infections, infusion or injection reactions and dermatological side effects. An overview of levels of evidence and recommendations is presented.
Original languageEnglish
Article numberB4652
JournalDanish Medical Journal
Volume60
Issue number6
Publication statusPublished - 2013

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Inflammatory Bowel Diseases
Immunosuppressive Agents
Ulcerative Colitis
Crohn Disease

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Theede, K., Dahlerup, J. F., Fallingborg, J., Hvas, C. L., Kjeldsen, J., Munck, L. K., & Nordgaard-Lassen, I. (2013). Biologic therapy in inflammatory bowel disease. Danish Medical Journal, 60(6), [B4652].
Theede, Klaus ; Dahlerup, Jens Frederik ; Fallingborg, Jan ; Hvas, Christian Lodberg ; Kjeldsen, Jens ; Munck, Lars Kristian ; Nordgaard-Lassen, Inge. / Biologic therapy in inflammatory bowel disease. In: Danish Medical Journal. 2013 ; Vol. 60, No. 6.
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Theede, K, Dahlerup, JF, Fallingborg, J, Hvas, CL, Kjeldsen, J, Munck, LK & Nordgaard-Lassen, I 2013, 'Biologic therapy in inflammatory bowel disease', Danish Medical Journal, vol. 60, no. 6, B4652.

Biologic therapy in inflammatory bowel disease. / Theede, Klaus; Dahlerup, Jens Frederik; Fallingborg, Jan; Hvas, Christian Lodberg; Kjeldsen, Jens; Munck, Lars Kristian; Nordgaard-Lassen, Inge.

In: Danish Medical Journal, Vol. 60, No. 6, B4652, 2013.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Biologic therapy in inflammatory bowel disease

AU - Theede, Klaus

AU - Dahlerup, Jens Frederik

AU - Fallingborg, Jan

AU - Hvas, Christian Lodberg

AU - Kjeldsen, Jens

AU - Munck, Lars Kristian

AU - Nordgaard-Lassen, Inge

PY - 2013

Y1 - 2013

N2 - In luminal Crohn's disease with moderate to severe inflammatory activity, infliximab and adalimumab can be used in the case of treatment failure with conventional therapies, such as systemic steroids and immunosuppressive therapy or if this treatment is not tolerated. Further treatment strategy depends on the primary response to induction therapy. Effect of maintenance therapy should be evaluated clinically and paraclinically at least every 26-52 weeks, and maybe supplemented by endoscopy or MRI scan. Decision of treatment discontinuation is based on disease manifestation, treatment response and paraclinical parameters. In fistulising Crohn's disease, treatment with infliximab or adalimumab can be initiated in simple fistula with rectal inflammation or complex fistula when the initial treatment has insufficient effect. Further treatment strategy depends on the primary response to induction therapy. Maintenance therapy is often necessary in complex fistulas. Treatment efficacy and possible discontinuation of treatment is evaluated at least every 26-52 weeks - if possibly with diagnostic imaging. In acute severe ulcerative colitis, treatment with infliximab can be used in patients with partial response after 3-5 days of treatment with a high-dose systemic steroid and when surgical treatment is not preferred or required. Further treatment strategy depends on the response to the first drug administration and colectomy should always be considered as an option. Effect of subsequent initiated maintenance therapy should be evaluated at least every 26-52 weeks on the basis of symptoms, clinical markers, paraclinical parameters and possibly by endoscopy. In chronic active ulcerative colitis, infliximab and adalimumab can be used in the case of treatment with immunosuppressive therapy fails and if surgery is not preferred. Further treatment strategy depends on the response to induction therapy. Treatment efficacy is assessed by symptoms, clinical markers, paraclinical parameters and possibly by endoscopy. Effect of maintenance therapy should be evaluated at least every 26-52 weeks. During treatment with biologic drugs focus should be on possible complications, such as infections, infusion or injection reactions and dermatological side effects. An overview of levels of evidence and recommendations is presented.

AB - In luminal Crohn's disease with moderate to severe inflammatory activity, infliximab and adalimumab can be used in the case of treatment failure with conventional therapies, such as systemic steroids and immunosuppressive therapy or if this treatment is not tolerated. Further treatment strategy depends on the primary response to induction therapy. Effect of maintenance therapy should be evaluated clinically and paraclinically at least every 26-52 weeks, and maybe supplemented by endoscopy or MRI scan. Decision of treatment discontinuation is based on disease manifestation, treatment response and paraclinical parameters. In fistulising Crohn's disease, treatment with infliximab or adalimumab can be initiated in simple fistula with rectal inflammation or complex fistula when the initial treatment has insufficient effect. Further treatment strategy depends on the primary response to induction therapy. Maintenance therapy is often necessary in complex fistulas. Treatment efficacy and possible discontinuation of treatment is evaluated at least every 26-52 weeks - if possibly with diagnostic imaging. In acute severe ulcerative colitis, treatment with infliximab can be used in patients with partial response after 3-5 days of treatment with a high-dose systemic steroid and when surgical treatment is not preferred or required. Further treatment strategy depends on the response to the first drug administration and colectomy should always be considered as an option. Effect of subsequent initiated maintenance therapy should be evaluated at least every 26-52 weeks on the basis of symptoms, clinical markers, paraclinical parameters and possibly by endoscopy. In chronic active ulcerative colitis, infliximab and adalimumab can be used in the case of treatment with immunosuppressive therapy fails and if surgery is not preferred. Further treatment strategy depends on the response to induction therapy. Treatment efficacy is assessed by symptoms, clinical markers, paraclinical parameters and possibly by endoscopy. Effect of maintenance therapy should be evaluated at least every 26-52 weeks. During treatment with biologic drugs focus should be on possible complications, such as infections, infusion or injection reactions and dermatological side effects. An overview of levels of evidence and recommendations is presented.

M3 - Journal article

C2 - 23743116

VL - 60

JO - Danish Medical Journal

JF - Danish Medical Journal

SN - 1603-9629

IS - 6

M1 - B4652

ER -

Theede K, Dahlerup JF, Fallingborg J, Hvas CL, Kjeldsen J, Munck LK et al. Biologic therapy in inflammatory bowel disease. Danish Medical Journal. 2013;60(6). B4652.