Management of inflammatory bowel disease with infliximab and other anti-tumor necrosis factor therapies: review of literature and case reports. Foreword.

摘要

The current goal of medical management of Crohn's disease (CD) is to induce and maintain remission and improve the patient's quality of life. The choice of drug therapy is guided by severity as well as by disease course over time. Although corticosteroids are associated with high initial rates of response, a considerable proportion of patients either fail to respond or become steroid-dependent. Corticosteroids do not maintain remission, prevent recurrence of disease after resection or heal the mucosa. Under the 'step-up' treatment paradigm, the probability of surgery remains high and a significant proportion of patients will also suffer intolerable side effects. Recent studies have shown that the use of systemic corticosteroids is associated with adverse outcomes such as serious infections and increased mortality. Although methotrexate and the purine antimetabolites, 6-mercaptopurine (6-MP) and azathioprine (AZA), have shown to be of significant benefit in steroid-dependent patients and in maintaining remission, their long-term benefit in altering the natural history of the disease remains debatable.