Anti-Tumour Necrosis Factor-α Therapy in Crohn’s Disease

Objectives: Crohn’s disease is a chronic, relapsing inflammatory disease of the gastro-intestinal tract. Tumour necrosis factor-alpha (TNF-α) is a pro-inflammatory protein that is believed to play a major role in the pathogenesis of Crohn’s disease (CD). Infliximab, a chimeric anti-TNF-α proclonal antibody, which inhibits the bioactivity of TNF-α, is a recent and exciting strategy in the treatment of CD. The purpose of this study was twofold. Firstly, the economic impact of infliximab therapy was examined. Secondly, chronic active Crohn’s dis-ease patients were analysed for their response to infliximab therapy. Patients and Methods: The medical records of 25 patients from the Department of Gastroenterology, AMNCH (Dublin) were analysed. Health-care utilization data were collected for each patient over the two years pre- and post-infliximab therapy. The medical records of all chronic active patients were analysed to investigate the role of infliximab as a steroid-sparing agent. The CDAI (Crohn’s Disease Activity Index) was employed as a reference for evaluating disease activity. Results: Following initiation of therapy with infliximab, the total number of hospital admis-sions decreased by 46.9%. The mean duration of hospital stays remained unchanged. The mean daily dosages of prednisolone decreased over the 12 months post-infliximab therapy, compared with the 12 months prior to therapy. Similarly, the mean daily dosage of budes-onide decreased in the 12-month period following initiation of infliximab therapy. Conclusion: The findings from this study of 25 patients with chronic active CD are comparable to those previously achieved in the controlled setting of clinical trials. In addition, this study demon-strated that infliximab may reduce the overall costs of management of Crohn’s disease by lim-iting associated health care utilization. Results also supported the theory that infliximab acts as a steroid-sparing agent. Further investigation into the impact of infliximab on healthcare usage and the prescription of corticosteroids could be an exciting and challenging field for research in the future