Número 3 - EII al día

RevisionesEnfermedad de CrohnIndicado tratamiento biológicoEnfermedad fistulosaEnfermedad luminal1ª opción: infliximabAlternativa: adalimumabEquivalente infliximab/adalimumabRespuestaPierde respuestaIntoleranciaIncrementar dosis o acortar intervalo de agente utilizadoCambio de anti-TNF (adalimumab por infliximab, y finalmente por certolizumab)Recupera y mantiene eficaciaNo recupera o pierde nuevamente eficaciaConsiderar otra causa de refractariedadSí la hayNo la hayTratamiento específicoConsiderar cirugíaCambio de TNF (adalimumab por infliximab, y finalmente por certolizumab)Figura 1. Recomendaciones de uso de agentes biológicos en los diferentes escenarios clínicos prácticos, teniendo en cuenta la autorización actualde la prescripción de los 3 anti-TNFα.BIBLIOGRAFÍA1. Munkholm P, Langholz E, Davidsen M, Binder V. Frequency of glucocorticoidresistance and dependency in Crohn’s disease. Gut 1994; 35:360–2.2. Candy S, Wright J, Gerber M, et al. A controlled double blind study ofazathioprine in the management of Crohn’s disease. Gut 1995; 37: 674–8.3. Travis SPL, Stange EF, Lemann M, et al. for the European Crohn’s and ColitisOrganisation (ECCO), European evidence based consensus on thediagnosis and management of Crohn’s disease: current management. Gut2006; 55 (Suppl. 1): i16–35.4. Sands BE, Arsenault JE, Rosen MJ, Alsahli M, Bailen L, Banks P et al. Riskof early surgery for Crohn’s disease: implications for early treatment strategies.Am J Gastroenterol 2003; 98: 2712–8.5. Wolters FL, Russel MG, Stockbrugger RW. Systematic review: has diseaseoutcome in Crohn’s disease changed during the last four decades? AlimentPharmacol Ther 2004; 20: 483–96.6. American Gastroenterological Association Consensus Development Conferenceon the Use of Biologics in the Treatment of Inflammatory BowelDisease, June 21–23, 2006. Gastroenterology 2007; 133: 312–39.7. Domènech E, Esteve M, Gomollón F, Hinojosa J, Panés J, Obrador A, GassullMA; Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa.GETECCU-2005 recommendations for the use of infliximab (Remicade) ininflammatory bowel disease. Gastroenterol Hepatol. 2005; 28: 126-34.8. Baert FJ, D´Haens GR, Peeters M, Hiele MI, Schaible TF, Shealy D y cols.Tmor necrosis factor alpha antoibody (infliximab) therapy profoundlydown-regulates the inflammation in Crohn´s ileocolitis. Gastroenterology1999; 116: 22-8.9. Fossati G, Nesbitt AM. IN vitro complement-dependent cytotoxicity andantibody-dependent cellular cytotoxicity by the anti TNF agents adalimumab,etanercept, infliximab and certolizumab pegol (CDP 870). Am J Gastroenterol2005; 100 (Supl 9): S 299 (abstract 807).10. Nesbitt A, Fossati G, Bergin M, Stephens P, Stephens S, Foulkes R, BrownD, Robinson M, Bourne T. Mechanism of action of certolizumab pegol(CDP870): in vitro comparison with other anti-tumor necrosis factor alphaagents. Inflamm Bowel Dis. 2007; 13: 1323-32.11. Targan SR, Hanauer SB, van Deventer SJ, Mayer L, Present DH, BraakmanT, et al. A short-term study of chimeric monoclonal antibody cA2 to tumornecrosis factor alpha for Crohn's disease. Crohn's Disease cA2 StudyGroup. N Engl J Med 1997; 337:1029-35.12. Hanauer SB, Feagan BG, Lichtenstein GR, Mayer LF, Schreiber S, ColombelJF, et al. Maintenance infliximab for Crohn's disease: the ACCENT Irandomised trial. Lancet 2002; 359:1541-9.13. Rutgeers P, D´Haens G, Targan S y cols. Efficacy and safety of retreatmentwith anti-tumor necrosis antibody (infliximab) to maintain remission inCrohn´s disease. Gastroenterology 1999; 117: 761-9.14. Present DH, Rutgeers P, Targan S y cols. Infliximab for the treatment of fistulasin patients with Crohn´s disease. N Engl J Med 1999; 340: 1398-405.15. Sands BE, Anderson FH, Bernstein CN, Chey WY, Feagan BG, Fedorak RN,Kamm MA, Korzenik JR, Lashner BA, Onken JE, Rachmilewitz D, Rutge-161 • Enfermedad Inflamatoria Intestinal al día - Vol. 7 - Nº. 2 - 2008