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L’infliximab dans le traitement prolongé de la maladie de Crohn non fistulisante

Long term treatment with infliximab in non-fistulising crohn’s disease

  • Published:
Acta Endoscopica

Résumé

L’Infliximab, un anticorps chimérique monoclonal IgG1 dirigé contre le TNF constitue le premier traitement biologique approuvé dans la maladie de Crohn (MC) et s’est avéré efficace dans le traitement de la MC luminale réfractaire ou intolérante au traitement standard par les glucocorticostéroïdes et/ou les immunodépresseurs. La stratégie optimale est l’induction thérapeutique par 5 mg/kg i.v. aux semaines 0-2-6, suivie d’un traitement systématique d’entretien toutes les 8 semaines. L’infliximab produit une cicatrisation rapide des lésions endoscopiques et histologiques. Le traitement d’entretien par infliximab procure une réduction du nombre de complications, d’hospitalisations, et d’interventions chirurgicales associées à la MC. La réponse à l’infliximab peut être renforcée par l’administration concomitante d’un traitement immunosuppresseur. Les problèmes de sécurité concernent principalement l’immunogénicité due à la formation d’anticorps anti-infliximab (ATI) qui peuvent conduire à des réactions perfusionnelles, à la perte de réponse et à des réactions sérologiques retardées induites par les perfusions. Les mesures destinées à réduire cette immunogénicité comportent au cours du traitement d’entretien, l’administration concomitante d’immunomodulateurs et en phase préthérapeutique, l’utilisation de corticoïdes. Une tuberculose latente doit être dépistée avant le début du traitement. D’autres affections opportunistes connaissent un taux légèrement supérieur, principalement chez les patients traités en même temps par immunomodulateurs. Les complications malignes chez les patients traités par anti-TNF ne sont pas accrues.

Summary

Infliximab, a chimeric monoclonal IgGl antibody to TNF is the first biological therapy approved for Crohn’s disease and is efficacious in patients with luminal Crohn’s disease refractory or intolerant to standard treatment with glucocorticosteroids and/or immunomodulators. The optimal strategy is induction therapy with infliximab 5 mg/kg IV at weeks 0-2-6 followed by systematic maintenance treatment every 8 weeks. Infliximab induces rapid endoscopic and histologic healing. Long-term maintenance therapy with infliximab results in a reduction of the rate of complications, hospitalisations and surgeries associated with Crohn’s disease. The response to infliximab may be optimized by concomitant immunosuppressive therapy. Safety problems mainly concern immunogenicity due to the formation of antibodies to infliximab (ATI) which may lead to infusion reactions, loss of response and serum sickness-like delayed infusion reactions. Actions to reduce immunogenicity include systematic maintenance therapy, concomitant use of immunomodulators and pre-treatment with corticosteroids. Latent tuberculosis needs to be screened for before onset of therapy. The rate of other opportunistic infections is slightly increased mainly in patients treated concomitantly with immunomodulators. Malignancy rates in patients treated with anti-TNF strategies are not increased.

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  1. Séverine Vermeire

    Present address: Division of Gastroenterology, University Hospitals, Leuven, Belgium

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  1. Division of Gastroenterology, University Hospitals, Leuven, Belgium

    G. Van Assche & P. Rutgeerts

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Vermeire, S., Van Assche, G. & Rutgeerts, P. L’infliximab dans le traitement prolongé de la maladie de Crohn non fistulisante. Acta Endosc 37, 271–283 (2007). https://doi.org/10.1007/BF02961917

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