Elf Jahre klinische Erfahrung mit Infliximab bei chronisch entzündlichen Darmerkrankungen in Göttingen - Eine retrospektive Studie

Eleven years of experience with infliximab for the treatment of inflammatory bowel disease at the Göttingen medical school – a retrospective single center study

von Vera Warnecke
Dissertation
Datum der mündl. Prüfung:2014-11-24
Erschienen:2014-11-18
Betreuer:Prof. Dr. Dirk Raddatz
Gutachter:Prof. Dr. Dirk Raddatz
Gutachter:Prof. Dr. Martin Oppermann
Gutachter:Prof. Dr. Rainer Mausberg
Zum Verlinken/Zitieren: http://dx.doi.org/10.53846/goediss-4781

 

 

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Englisch

Background: In several randomized studies, infliximab has proven to be efficacious for induction and maintenance of clinical remission for the treatment of inflammatory bowel disease (IBD). This new treatment option led to routine application of infliximab in particular in the last decade. This retrospective study summarizes the experience and assesses the long-term benefit and safety of infliximab for the treatment of IBD at the Göttingen medical school. Methods: From August 1999 to August 2010, 85 patients affected by IBD were treated with infliximab. The therapeutic benefit was assessed by investigating the endoscopic response, the rate of surgical interventions and the course of concomitant medications such as corticosteroids and azathioprine/6-mercaptopurine. Discontinuation rates and frequency as well as intensity of adverse effects were counted to develop a safety profile. Predictive parameters for mucosal healing and primary resistance were analyzed. Results: Infliximab was administered for a mean of 26.5 months, on average 15 infusions per patient. 46 % of patients with Crohn´s disease (CD) and 71 % of patients with ulcerative colitis (UC) showed a positive endoscopic response, 39 % reached mucosal healing. Although we could not find any significant predictive parameter for mucosal healing, the concomitant medication with azathioprine/6-mercaptopurine seemed to be supportive. 8.8 % of the patients needed at least one surgical intervention. 54.3 % of the patients who received corticosteroids at baseline could stop the treatment after a mean of 15.5 months. 40 % of the patients who were treated with azathioprine/6-mercaptopurine at baseline stopped the medication after a mean of 20.5 months. In 63.5 % of the collective, the infliximab treatment was discontinued because of adverse effects, primary or secondary resistances. In total, gentle to severe adverse effects occurred to 55.3 % of the patients. 11.8 % of the collective showed a primary resistance. Despite the lack of any significant predictive parameter for primary resistance, by trend CD-patients, inflammation localizations at ileum and/or jejunum and males seemed to show less initial response. Conclusion: In summary, we can confirm the previously demonstrated success of infliximab used in the therapy of severe IBD. Infliximab is a safe treatment option for patients who failed conventional medication.
Keywords: inflammatory bowel disease; infliximab; long-term
Schlagwörter: chronisch entzündliche Darmerkrankungen; Infliximab; Langzeit
 
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