Traitement de la maladie de Crohn de l'adulte par anticorps anti-tumor necrosis factor-alpha (TNF alpha)

Crohn's disease (CD) is a chronic inflammatory disease of the bowel characterized by segmental transmural inflammation and granulomatous changes. TNF alpha is a member of a large family of proteins and receptors that are involved in immune regulation. It is a proinflammatory and immunoregulatory cytokine synthesized by monocytes, macrophages, and T cells. TNF alpha plays an early central role in the cytokine cascade of the inflammatory process. Recently, chimeric monoclonal antibodies that inhibits TNF alpha have been used in the treatment of Crohn's disease. Infliximab has been the most largely used antibody. It is commercialized in the USA and has recently obtained an European marketing approvement. Infliximab is indicated for the treatment of moderately to severely active CD in patients having an inadequate response to conventional therapy. Clinical trials have demonstrated efficacy when the agent is initiated as a 5 mg/kg single intravenous infusion. In patients with fistulizing CD, administration of 2 subsequent 5 mg/kg doses 2 and 6 weeks after the initial dose appears to be efficacious. Limited clinical data also suggest that infliximab retreatment regimen restores response and maintains remission rates. Infliximab appears to be well tolerated. To date, very little is known about the potential for long-term toxicity with infliximab therapy.