Abstract
The natural course of Crohns disease is characterized by the progression from primarily inflammatory disease to a complicated stricturing or penetrating disease. These irreversible complications lead to repeated surgery and considerable disability. Therefore it may be argued that a window of opportunity for intensive treatment exists early in the disease course. Healing of the mucosa has been shown to be a strong predictor of improved outcome of Crohns disease on the long-term, in terms of disease control, hospitalizations, and surgery. Anti-tumor necrosis factor (TNF)-α therapy has shown to be a strong inducer of mucosal healing and it may be argued that early treatment with anti-TNFs and/or immunomodulators may be the preferable approach in selected patients. The main concern with such strategies is safety, especially the risk of lymphomas and infections. This paper aims to review the existing data regarding the benefits and disadvantages of inverting the classic step up therapeutic paradigm.
Keywords: Crohn's disease, top-down, step-up, tumor necrosis factor-α, immunomodulators, mucosal healing, course of disease, immunosuppression
Current Drug Targets
Title: Anti-TNF and Crohns Disease: When Should we Start?
Volume: 11 Issue: 2
Author(s): H. H. Fidder and D. W. Hommes
Affiliation:
Keywords: Crohn's disease, top-down, step-up, tumor necrosis factor-α, immunomodulators, mucosal healing, course of disease, immunosuppression
Abstract: The natural course of Crohns disease is characterized by the progression from primarily inflammatory disease to a complicated stricturing or penetrating disease. These irreversible complications lead to repeated surgery and considerable disability. Therefore it may be argued that a window of opportunity for intensive treatment exists early in the disease course. Healing of the mucosa has been shown to be a strong predictor of improved outcome of Crohns disease on the long-term, in terms of disease control, hospitalizations, and surgery. Anti-tumor necrosis factor (TNF)-α therapy has shown to be a strong inducer of mucosal healing and it may be argued that early treatment with anti-TNFs and/or immunomodulators may be the preferable approach in selected patients. The main concern with such strategies is safety, especially the risk of lymphomas and infections. This paper aims to review the existing data regarding the benefits and disadvantages of inverting the classic step up therapeutic paradigm.
Export Options
About this article
Cite this article as:
Fidder H. H. and Hommes W. D., Anti-TNF and Crohns Disease: When Should we Start?, Current Drug Targets 2010; 11 (2) . https://dx.doi.org/10.2174/138945010790309993
DOI https://dx.doi.org/10.2174/138945010790309993 |
Print ISSN 1389-4501 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-5592 |
Call for Papers in Thematic Issues
New drug therapy for eye diseases
Eyesight is one of the most critical senses, accounting for over 80% of our perceptions. Our quality of life might be significantly affected by eye disease, including glaucoma, diabetic retinopathy, dry eye, etc. Although the development of microinvasive ocular surgery reduces surgical complications and improves overall outcomes, medication therapy is ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
Related Articles
-
Mechanism-Based Inhibitors from Phytomedicine: Risks of Hepatotoxicity and their Potential Hepatotoxic Substructures
Current Drug Metabolism Monoclonal Antibodies in the Treatment of Multiple Sclerosis
Current Medicinal Chemistry Tumor Control by Manipulation of the Human Anti-Apoptotic Survivin Gene
Current Cancer Therapy Reviews HSF1, A Versatile Factor in Tumorogenesis
Current Molecular Medicine Protein Modification by β-N-Acetyl Glucosamine (O-GlcNAc) in Insulin Signaling and Insulin Resistance
Recent Patents on Endocrine, Metabolic & Immune Drug Discovery An Integrative Informatics Approach to Explain the Mechanism of Action of N1-(Anthraquinon-2-yl) Amidrazones as BCR/ABL Inhibitors
Current Computer-Aided Drug Design Bioactive Natural Compounds from the Mangrove Endophytic Fungi
Mini-Reviews in Medicinal Chemistry The Cytokine Network in HIV Infection
Current Molecular Medicine Pro-inflammatory Cytokines in Animal and Human Gestation
Current Pharmaceutical Design Potentiation of PBD Dimers by Lipophilicity Manipulation
Current Topics in Medicinal Chemistry Novel Drug Targets in Malaria Parasite with Potential to Yield Antimalarial Drugs with Long Useful Therapeutic Lives
Current Pharmaceutical Design Therapeutic Monoclonal Antibodies: Strategies and Challenges for Biosimilars Development
Current Medicinal Chemistry Signal Transduction Pathways and Transcriptional Mechanisms as Targets for Prevention of Emergence of Multidrug Resistance in Human Cancer Cells
Current Drug Targets Exosomes: A Role for Naturally Occurring Nanovesicles in Cancer Growth, Diagnosis and Treatment
Current Gene Therapy Nanoparticle Drug Delivery Systems: Recent Patents and Applications in Nanomedicine
Recent Patents on Nanomedicine Hepatocyte Growth Factor and Insulin-like Growth Factor-1 based Cellular Therapies for Oxidative Stress Injury
Current Stem Cell Research & Therapy Traditional Chinese Medicines (TCMs) for Molecular Targeted Therapies of Tumours
Current Drug Discovery Technologies Current Dendrimer Applications in Cancer Diagnosis and Therapy
Current Topics in Medicinal Chemistry Clinical Studies with Bismuth-213 and Actinium-225 for Hematologic Malignancies
Current Radiopharmaceuticals Signaling Mechanism for the Insulin-like Effects of Growth Hormone - Another Example of a Classical Hormonal Negative Feedback Loop
Current Drug Targets - Immune, Endocrine & Metabolic Disorders