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Infliximab for Crohn's disease in the Swiss IBD Cohort Study: clinical management and appropriateness

Juillerat, Pascal
Pittet, Valerie
Gonvers, Jean-Jacques
Mottet, C.
Seibold, F.
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CollaborationWith : Tempia-Caliera Schaeppi, Michela
Published in European Journal of Gastroenterology and Hepatology. 2010, vol. 22, no. 11, p. 1352-1357
Abstract OBJECTIVE: Antitumor necrosis factor a agents have significantly improved the management of Crohn's disease (CD), but not all patients benefit from this therapy. We used data from the Swiss Inflammatory Bowel Disease Cohort Study and predefined appropriateness criteria to examine the appropriateness of use of infliximab (IFX) in CD patients. METHODS: EPACT II (European Panel on the Appropriateness of CD Therapy, 2007; www.epact.ch) appropriateness criteria have been developed using a formal explicit panel process combining evidence from the published literature and expert opinion. Questionnaires relating to EPACT II criteria were used at enrollment and follow-up of all Swiss Inflammatory Bowel Disease Cohort Study patients. A step-by-step analysis of all possible indications for IFX therapy in a given patient allowed identification of the most appropriate indication and final classification in a single appropriateness category (appropriate, uncertain, inappropriate). RESULTS: Eight hundred and twenty-one CD patients were prospectively enrolled between November 2006 and March 2009. IFX was administered to 146 patients (18%) at enrollment and was most frequently used for complex fistulizing disease and for the maintenance of remission induced by biological therapy. IFX therapy was considered appropriate in 44%, uncertain in 44%, and inappropriate in 10% of patients. CONCLUSION: In this cohort, 9 out of 10 indications for IFX therapy were clinically generally acceptable (appropriate or uncertain) according to EPACT II criteria. Uncertain indications resulted mainly from the current more liberal use of IFX in clinical practice as compared with the EPACT II criteria.
Keywords AdolescentAdultAnti-Inflammatory Agents/*therapeutic useAntibodies, Monoclonal/*therapeutic useCrohn Disease/diagnosis/*drug therapyFemaleGastrointestinal Agents/*therapeutic useGuideline AdherenceHumansMalePatient SelectionPractice Guidelines as TopicPredictive Value of TestsProspective StudiesSeverity of Illness IndexSwitzerlandTreatment OutcomeYoung Adult
PMID: 20964261
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Research group Gastroentérologie et transplantation (pédiatrie) (181)
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JUILLERAT, Pascal et al. Infliximab for Crohn's disease in the Swiss IBD Cohort Study: clinical management and appropriateness. In: European Journal of Gastroenterology and Hepatology, 2010, vol. 22, n° 11, p. 1352-1357. https://archive-ouverte.unige.ch/unige:21030

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Deposited on : 2012-05-23

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