Current Drug Targets - Volume 11, Issue 2, 2010

Crohn's disease is a chronic inflammatory bowel disease (IBD) that can affect the whole gastrointestinal tract, especially the ileo-colonic tract. The etiology of the disease still remains unknown [1]. Several mechanisms involved in the pathogenesis of the disease have been investigated, and Tumour Necrosis Factor (TNF)-α pathway seems to play a crucial role in the onset and maintenance of the chronic inflammatory process Read More

Several TNF antagonists, mainly monoclonal antibodies, have shown to be efficacious in the therapy of Crohn's disease. Despite the fact that they have been used for over a decade, their precise mechanism of action is still a matter of investigation. The effects of anti-TNF agents are mediated by multiple mechanisms including direct neutralization of soluble TNF and interaction with membrane-bound TNF. Anti-TNF agents may a Read More

The natural course of Crohn's disease is characterized by the progression from primarily inflammatory disease to a complicated stricturing or penetrating disease. These irreversible complications lead to repeated surgery and considerable disability. Therefore it may be argued that a window of opportunity for intensive treatment exists early in the disease course. Healing of the mucosa has been shown to be a strong p Read More

When to stop anti-TNF therapy in Crohn's disease (CD)? This is a very important question both for patients and physicians. There is no published evidence to clearly and definitely answer this question. However data on natural history of CD, long term safety of biologics, outcome after immunosuppressors (IS) cessation and some preliminary studies on biologics cessation may help us to discuss this topic. One could argu Read More

Despite the fact that anti-TNF alpha antibodies are well-tolerated and highly effective in Crohn's disease 25% to 40% of patients who initially benefited from the treatment are developing intolerable adverse events or are losing their response during maintenance therapy. The molecular mechanisms of loss of response are not fully understood, but clinicians face this clinical problem. The Aim of this paper is to review the c Read More

The introduction in the mid-1990s of tumor necrosis factor (TNF) antagonists changed the treatment of inflammatory bowel diseases (IBD), Crohn's disease and ulcerative colitis (UC), refractory to conventional medications (corticosteroids, immunomodulators). This review summarizes current data on the long-term efficacy and safety of anti- TNF therapy in IBD beyond 1 year. We searched Medline, the Cochrane Library, Embas Read More

Today up to 40% of Crohn's disease patients receive a concomitant therapy of TNF blockers in combination with thiopurines or methotrexate. Although data of prospective controlled trails are rare, some recently published studies indicate a more rapid onset of remission and increased mucosal healing following concomitant therapy in short term. However, data confirming the need or benefit of concomitant immunosup Read More

Tumour necrosis factor alpha (TNF-alpha) inhibitors ensure valuable treatment advantages for patients with inflammatory bowel diseases (IBD) by offering a more targeted anti-inflammatory therapy. In contrast, there is concern that it might increase the risk of long-term complications including infections and the risk for malignancies and non- Hodgkin's lymphoma (NHL). Although the results from hospital- and populatio Read More

Perianal fistulas are a major problem of patients with Crohn's disease (CD), and occur in up to 40 % of patients. The treatment of fistulising perianal CD has recently largely evolved as a result of improvements of pharmacological and surgical approaches and the introduction of anti-TNF treatment. Especially the use of anti-TNF agents in complex or refractory perianal fistulas has been proven as the most effective medica Read More

The advent of biological therapy has had a significant impact on the management of patients with inflammatory bowel disease. Nevertheless, anti-TNF-alpha agents are still used with caution, driven by concerns about the risk of infection. Stringent post-marketing surveillance programmes and registries have allowed early recognition of problems, highlighting an increased risk of infectious complications. Although the focus is on Read More

Recurrence of Crohn's disease (CD) is extremely frequent after surgery and its prevention remains a fundamental problem in the medical management of these patients. As of today, none of the medications traditionally used to treat the spontaneous disease (i.e. mesalamine, steroids, immunosuppressives and antibiotics) has shown a clear benefit. Recent data, coming from our center and from a small RCT do indicate Read More

Mucosal healing has been incorporated in the assessment of treatment efficacy in ulcerative colitis, but in Crohn's disease this concept has only emerged after biological therapies have been evaluated in clinical trials. Systemic steroids don't induce mucosal healing in Crohn's disease, but purine analoges and anti TNF agents have a potential to heal mucosal ulcerations. Evidence for mucosal healing has now been provided Read More

The incidence of inflammatory bowel disease (IBD; Crohn’s disease, ulcerative colitis) is highest during the peak reproductive years, hence the increased concern with the safety of IBD drugs during pregnancy. Over the past 11 years, anti-TNF-α antibody therapy has emerged as a treatment approach for refractory IBD patients who have failed to achieve or maintain remission with corticosteroids and immunomodulator agent Read More

Crohn's disease (CD) is a chronic panenteric disease of unknown aethiology which tends to progress in spite of medical or surgical treatment. Intestinal fibrosis is among the most common complications of CD, resulting in stricture formation in the small intestine and colon. About 75% of CD patients will undergo surgery at least once over the course of their disease and fibrotic strictures represent the main indication for surg Read More

Inflammatory bowel diseases (IBD) are idiopathic chronic inflammations: the etiology of Crohn's disease (CD) and ulcerative colitis (UC) is still largely unknown. Environmental and genetic factors in combination with the microbial flora or specific microorganisms trigger an event, leading to the activation of an intestinal immune response. Immune and non-immune cells create a cross talk via the secretion of soluble mediator Read More