Healio Rheumatology, June 2017
Edouard Louis, MD, PhD
A: The inflammatory bowel diseases are chronic, relapsing inflammatory disorders of the gastrointestinal tract with a propensity to develop tissue damage — including fibrosis and strictures — penetrating lesions and fistulas, and small bowel and colorectal cancer. Therefore, the aim of treatment is no longer a simple clinical response or even remission, but a state of biological and tissue remission ideally associated with the absence of disease progression. Any therapeutic decision in inflammatory bowel disease, either escalating or de-escalating the treatment, must be made by taking this into account.
Anti-tumor necrosis factors (TNFs), including infliximab, adalimumab and certolizumab pegol for Crohn’s disease (CD) and infliximab and adalimumab for ulcerative colitis (UC), have been used in clinical trials and routine practice for more than 10 years. These have been associated with long-term benefits, such as sustained clinical remission, mucosal healing, fistula healing, decreased number of hospitalizations, decreased number of surgeries, increased quality of life and the ability to work and perform activities of daily living. These have been associated with a reasonably good safety profile and, globally, a favorable benefit/risk ratio. The most striking risks are opportunistic infections, mainly tuberculosis (incidence of approximately one per 1,000 patients per year) and lymphomas (fewer than one per 1,000 treated patients).