Medical Management 3: Biologicals
Anti-tumour necrosis factor (anti-TNF) agents have led to major progress for IBD patients refractory to conventional treatment (corticosteroids and immunosuppressive therapy). Infliximab and adalimumab have proven their efficacy for inducing and maintaining remission in CD and UC, and infliximab is also effective for acute severe colitis and perianal fistulising Crohn’s disease. For both diseases a third anti-TNF agent has demonstrated its efficacy in a randomized controlled trial. Golimumab is available for UC patients and certolizumab pegol for CD patients, but the latter only in Switzerland and Northern America.
However, managing IBD remains challenging as prognosis and outcome vary between patients. Moreover, one-third of IBD patients seem to be primary non-responders, and an additional 40% loses effect over time (secondary nonresponders).
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