Article
Infliximab for treatment of pyoderma gangrenosum associated with clinically inactive Crohn's disease. A case report.
General Army Hospital, Thessaloniki, and Medical School Democritus University of Thrace, Alexandroupolis, Greece.
Romanian journal of gastroenterology
01/2006;
14(4):401-3.
pp.401-3
Source: PubMed
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Article: Anti-TNF strategies in Crohn's disease: mechanisms, clinical effects, indications.
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ABSTRACT: Although the cause of Crohn's disease remains obscure, considerable progress has been made in recent years in unraveling the pathogenesis of the inflammatory processes seen in chronic idiopathic inflammatory bowel diseases. Th-1 lymphocytes seem to orchestrate the inflammation through the production of proinflammatory cytokines such as interferon-gamma, interleukin-1 beta, and tumor necrosis factor (TNF) alpha. Since the isolation and characterization of TNF and its two receptors detailed regulatory processes for transcription, secretion, and postreceptor actions of TNF are now rapidly being discovered. Genetically engineered monoclonal antibodies specifically directed against TNF-alpha are only the first drugs acting against TNF, available for clinical use now in the treatment of Crohn's disease. A single intravenous injection of these mono-antibodies produce very dramatic clinical, endoscopic, and histological responses in most refractory patients. More data on long-term safety, efficacy (mainly after repeated infusions) and the exact role in combination with standard therapies are awaited. Until then these drugs should be reserved for patients not responding to standard immunomodulatory therapy and not amenable to surgery. The exciting "TNF story" very nicely illustrates how the benchmark of basic immunological research now provides us with very potent and rationally designed drugs. Careful monitoring of safety of repeated and long-term use of these agents, interfering with very basic physiological events, is mandatory.International Journal of Colorectal Disease 03/1999; 14(1):47-51. · 2.38 Impact Factor -
Article: Infliximab for treatment of pyoderma gangrenosum associated with inflammatory bowel disease.
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ABSTRACT: Pyoderma gangrenosum is an immune-mediated inflammatory condition characterized by ulcerative skin lesions affecting 1-2% of patients with inflammatory bowel disease (IBD). Treatment includes wound care, antibiotics, corticosteroids, and immunomodulators. However, response to therapy varies, and many patients with pyoderma gangrenosum have disease that is refractory to these agents. The aim of this study was to assess the response of medically refractory pyoderma gangrenosum to infliximab. This was a multicenter retrospective study of patients with IBD and medically refractory pyoderma gangrenosum treated with infliximab. Data collected included the following: baseline demographics; duration of IBD; history of bowel resection; duration of skin lesions; number, size, and location of pyoderma gangrenosum lesions; prior medications; dose and number of infliximab infusions; bowel activity before and after infliximab; pyoderma gangrenosum activity before and after infliximab therapy; time to response and time to healing of pyoderma gangrenosum lesions; recurrence of pyoderma gangrenosum after infliximab; corticosteroid taper; and adverse reactions to infliximab. There were 13 patients with moderate to severe pyoderma gangrenosum and IBD treated with infliximab. All patients demonstrated complete healing of the skin lesions. Three patients had a complete response to induction infliximab therapy and did not require additional treatment. Ten patients responded to induction infliximab and have maintained pyoderma gangrenosum healing with infusions every 4-12 wk. All patients receiving corticosteroids were able to discontinue them completely after institution of infliximab treatment. Infliximab was well tolerated; the only treatment-related adverse events were sunburn in one patient and an infusion reaction in another. Infliximab is a safe and effective treatment for IBD-associated pyoderma gangrenosum.The American Journal of Gastroenterology 09/2003; 98(8):1821-6. · 7.28 Impact Factor -
Article: Surgical management of pyoderma gangrenosum: case report and review.
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ABSTRACT: Commonly used treatments for pyoderma gangrenosum are medical, with immunosuppressive agents employed most often. To report a case and discuss the indications for radical surgical treatment of pyoderma gangrenosum. Analysis of a case of Crohn's disease-associated pyoderma gangrenosum treated with immunosuppression followed by amputation, and a review of the literature on surgical management of pyoderma gangrenosum. In unstable patients with intractable multiple medical problems, surgical treatment of pyoderma gangrenosum may be indicated by the existence of these life-threatening comorbidities. The recent literature suggests that surgical management of pyoderma gangrenosum may also be appropriate in other special circumstances. Surgical management, including amputation, may have a role in the management of pyoderma gangrenosum. Further research is needed to delineate precisely the circumstances and patient factors that are appropriate indications for such surgery.Dermatologic Surgery 12/2000; 26(11):1063-6. · 1.80 Impact Factor
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Keywords
case report
chimeric monoclonal antibody
clinically inactive Crohn's disease
Crohn's disease
fistulizing Crohn's disease
inflammatory bowel disease
Infliximab
inhibits tumour necrosis factor alpha
successful treatment
therapeutic agent
TNF-alpha
treatment pyoderma gangrenosum
