Recommendations for the treatment of ulcerative colitis with infliximab: A gastroenterology expert group consensus
Recommendations for the treatment of ulcerative colitis with infliximab: A gastroenterology expert group consensus
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DOI：
10.1016/j.crohns.2011.11.001
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发表时间：
2012-03-01
影响因子：
8
通讯作者：
Panes, Julian
中科院分区：
文献类型：
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作者：
Reinisch, Walter;Van Assche, Gert;Panes, Julian
背景和目的：英夫利昔单抗是目前唯一被批准用于治疗对常规治疗无反应的中度至重度活动性溃疡性结肠炎（UC）成人的生物制剂。它能迅速控制症状，诱导并维持无类固醇缓解，刺激粘膜愈合，减少严重并发症。虽然英夫利昔单抗倾向于为重症患者保留，但它可能对病程早期的中度疾病更有益。因此，确定哪些患者适合英夫利昔单抗治疗是很重要的。方法：一个由12名在临床实践和临床试验中使用英夫利昔单抗经验丰富的胃肠病学家组成的专家小组，通过合作德尔菲调查，就UC患者使用生物治疗达成共识。该小组还讨论了影响英夫利昔单抗在UC中使用的问题，包括其作为手术替代方案的潜力。结果：专家组一致认为：(1)有必要采用症状控制以外的其他治疗目标，即粘膜完全愈合，无类固醇缓解，改善生活质量，减少长期并发症；(2)英夫利昔单抗有可能实现这些治疗目标，特别是在UC病程早期使用；(3)对于考虑结肠切除术的患者，应提供英夫利昔单抗作为手术的替代方案。专家组还就确定英夫利昔单抗治疗候选者的因素达成一致（例如，持续性活动性UC、类固醇依赖/难治性疾病和高c反应蛋白）。结论：这一共识声明提供了关于如何使用英夫利昔单抗实现中重度UC治疗目标的有用和实用信息。(C) 2011年由Elsevier B.V.代表欧洲克罗恩病和结肠炎组织出版。
Background and aims: Infliximab is currently the only biologic approved for treatment of adults with moderate to severe, active ulcerative colitis (UC) unresponsive to conventional therapies. It rapidly controls symptoms, induces and sustains steroid-free remission, stimulates mucosal healing, and reduces serious complications. Although infliximab tends to be reserved for patients with severe disease, it may be even more beneficial for moderate disease earlier in the disease course. Therefore, it is important to identify which patients are candidates for infliximab therapy.Methods: A collaborative Delphi survey was used to obtain consensus on use of biologic therapy in patients with UC from an expert panel of 12 gastroenterologists with substantial experience using infliximab in clinical practice and clinical trials. The panel also addressed issues that influence the use of infliximab in UC, including its potential as an alternative to surgery.Results: The panel agreed that: (1) it is necessary to adopt additional treatment goals beyond symptom control, i.e., complete mucosal healing, steroid-free remission, improved QoL, and reduced long-term complications; (2) it may be possible to achieve these treatment goals with infliximab, especially if it is used earlier in the course of UC; and (3) infliximab should be offered as an alternative to surgery in patients being considered for colectomy. The panel also agreed on factors for identifying candidates for infliximab therapy (e.g., persistently active UC, steroid-dependent/refractory disease, and high C-reactive protein).Conclusions: This consensus statement provides useful and practical information on how to achieve evolving treatment goals with infliximab in moderate to severe UC. (C) 2011 Published by Elsevier B.V. on behalf of European Crohn's and Colitis Organisation.