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Related Concept Videos

Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF01:24

Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF

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Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab...
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Inflammatory Bowel Disease IV: Pharmacological Management01:29

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Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...
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Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents01:29

Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents

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Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
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Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy01:30

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Various diagnostic tests are employed in the diagnostic process for Inflammatory Bowel Disease (IBD), particularly to differentiate between Crohn's disease and ulcerative colitis.
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
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Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids01:21

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Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
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Inflammatory Bowel Disease II: Crohn's Disease01:30

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Introduction
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
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Related Experiment Video

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Multimodal Quantitative Phase Imaging with Digital Holographic Microscopy Accurately Assesses Intestinal Inflammation and Epithelial Wound Healing
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Predictive Model for Outcomes in Inflammatory Bowel Disease Patients Receiving Maintenance Infliximab Therapy.

Rochelle Wong1, Paris Charilaou2, Amy Hemperly3

  • 1Division of Gastroenterology and Liver Diseases, Department of Medicine, University of Southern California, Los Angeles, CA, USA.

Crohn'S & Colitis 360
|December 16, 2024
PubMed
Summary

A new model predicts unfavorable outcomes in inflammatory bowel disease (IBD) patients on infliximab therapy. Low infliximab levels and high histology scores identify high-risk individuals for better IBD management.

Keywords:
endoscopyinfliximabmaintenancepathologypredictive model

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Area of Science:

  • Gastroenterology
  • Immunology
  • Pharmacology

Background:

  • Predictive models for inflammatory bowel disease (IBD) patient outcomes on maintenance infliximab therapy are lacking.
  • This study aimed to develop a predictive model for unfavorable outcomes in these patients.

Purpose of the Study:

  • To create and validate a predictive model for unfavorable outcomes in adult IBD patients receiving maintenance infliximab therapy.
  • To identify key predictors of active inflammation, surgery, or hospitalization.

Main Methods:

  • Adult IBD patients on maintenance infliximab therapy were included from two centers.
  • Serum infliximab concentrations and histologic scores (Robarts Histopathologic Index [RHI]) were assessed.
  • A multivariable model was developed and internally/externally validated using area under the receiver-operating curve (AUC).

Main Results:

  • 40.7% of patients experienced unfavorable outcomes.
  • Low infliximab concentration (<9.3 µg/mL) and high RHI (>12) were significant predictors (OR 5.3 and 3.4, respectively).
  • The 2-predictor model showed good discrimination (AUC 0.71 internal, 0.73 external); infliximab concentration alone performed similarly.

Conclusions:

  • A 2-predictor model using infliximab concentration and histology effectively identifies IBD patients at high risk for unfavorable outcomes.
  • For practical application, infliximab concentration alone provides similar predictive performance.
  • This model aids in optimizing IBD management for patients on infliximab therapy.