anti-TNF

anti-TNF

Infliximab is an important advance in the treatment of Crohn's disease. Although its mechanism is incompletely understood, it is an antibody that appears to bind human tumor necrosis factor (TNF-α) to soluble cell membranes. This makes TNF-α inactive and inhibits the inflammatory process. The clinical response to infliximab is prompt, with two thirds of patients reporting a reduction in clinical symptoms and one half of these reporting clinical remission. The maintenance of response is variable, with some patients relapsing after only a few weeks to others maintaining remission for six months or more. Hence, infusions may need to be repeated every two to six

weeks. The durability of response seems to diminish over time, however, and intermittent utilization leads to allergic-like reactions. Recently, a second anti-TNF agent was launched on the market: adalimumab. This drug differs from infliximab: it is a fully human IgG1 monoclonal antibody. Adalimumab has proved highly effective in inducing remission in early Crohn's disease, suggesting that disease duration is a significant contributor to the likelihood of achieving remission. Furthermore, patients who have lost response or become intolerant to infliximab can have rapid responses to adalimumab. See also anti-TNF in the section on rheumatoid arthritis.

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The greatest benefit of infliximab therapy for Crohn’s disease is: