Treatment of Crohn's disease with infliximab: first choice?

Background - Crohn's disease is a chronic inflammatory disorder of the gastrointestinal tract with difficult management. Infliximab is a chimeric IgG1 monoclonal antibody against tumor necrosis factor and is indicated for refractory luminal and fistulization in Crohn's disease. Aim - To observe the outcome of 60 patients with diagnosis of Crohn's disease treated with infliximab. Methods - Prospective study with 60 patients with Crohn's disease in six years of observation. Exclusion criteria were: clinical infection in at last three months; tuberculosis; intestinal occlusion; pregnancy. All patients were submitted to thorax X-rays, leukogram, tuberculosis cutaneous test. They were treated with infliximabe 5mg/kg each two months. They were divided into three groups according to the time of the diagnosis: 5 years, 6 to 10 and more than 10 years. The results were considered better, worse or unchanged. Results - After the initial treatment, 76% of the patients achieved a response. At the first dose, the ones with 10 years and with associated abdominal surgery had good results and similar to the ones with less than 5 years with no operations. Conclusion - The treatment with infliximab was effective and tolerable in the managing of symptoms in patients with active Crohn's disease, refractory to the conventional treatment and can be a reasonable approach to avoid the surgical treatment.