IBD Watch^®

^{Timely Information for Practicing Physicians}

MAY 2003

INFLIXIMAB

Antibody formation to infliximab.  Richard Farrell et al (Boston, MA) prospectively evaluated 53 CD patients treated with infliximab (5 mg/kg; 199 infusions) and conducted a controlled trial in which 80 CD patients were randomized to receive either hydrocortisone (200 mg) or placebo prior to infliximab infusions.  They found that 19 (36%) prospectively evaluated patients developed antibodies to infliximab, which were associated with serious infusion reactions (7 of 7 patients) and the loss of initial responsiveness (11 of 15 initial responders vs. 0 of 21 responders without infliximab antibody formation).  Antibody formation was reduced by concurrent administration of immunosuppressives or by giving a second infliximab infusion within 8 weeks of the first infusion.  In the placebo-controlled trial, IV hydrocortisone treatments lowered infliximab antibody serum levels (1.6 vs. 3.4 mg/mL) and decreased the percentage of patients developing antibodies to infliximab (26% vs. 42%). These findings demonstrate that loss of initial response and infusion reactions are associated with infliximab antibody formation and that hydrocortisone premedication reduces the frequency and serum levels of antibodies against infliximab.  However, hydrocortisone premedication does not eliminate the development of antibodies to infliximab.  (Farrell RJ, et al. Gastroenterology 2003;124: 917-924)

URSODEOXYCHOLIC ACID (UDCA)

Chemoprevention.  Darrell Pardi et al followed patients with concomitant UC and PSC who were randomized to receive UDCA or placebo in a previous trial.  Fifty-two patients were followed for 355 person-years; compared to the placebo group, UDCA-treated patients had a relative risk (RR) of 0.26 for developing colorectal dysplasia or cancer. Patients from the placebo group who eventually received open-label UDCA gained a similar protective effect (RR, 0.26).  These data provide supportive evidence for the chemoprotective effects of UDCA treatment in patients with UC and PSC.  (Pardi DS, et al. Gastroenterology 2003;124:889-893)

CHROMOENDOSCOPY

Detection of intraepithelial neoplasia and colon cancer.  Ralf Kiesslich and colleagues at the University of Mainz (Germany) randomized 165 UC patients to either conventional colonoscopy or chromoendoscopy using 0.1% methylene blue.  Improved correlation between endoscopic assessment of the extent and degree of colonic inflammation and histopathologic findings was realized with chemoendoscopy compared to colonoscopy.  Chromoendoscopy also increased the number of identified targeted biopsies, which resulted in the detection of a greater number of intraepithelial neoplasias (32 vs. 10; p = 0.003).  Both the sensitivity and specificity for distinguishing non-neoplastic from neoplastic lesions were 93%.  These results suggest that chromoendoscopy allows for a more accurate assessment of the inflammatory activity in UC and is a novel diagnostic tool for the early detection of intraepithelial neoplasia and colon cancer in patients with UC.  (Kiesslich R, et al. Gastroenterology 2003;124:880-888)

CROHN'S DISEASE (CD)

Risk factors for the development of stricturing or penetrating disease.  Edouard Louis and associates studied 163 patients with non-penetrating, non-stricturing CD at diagnosis.  Five years after diagnosis 18 (11%) patients had developed stricturing disease and 35 (21.5%) had developed penetrating disease.  Multivariate analysis identified ileal location of disease to be predictive for a stricturing disease pattern and a high number of flares, and active smoking to be predictive for a penetrating disease pattern.  This investigation indicates that development of a stricturing or penetrating disease pattern in CD patients is affected by disease location, number of flares, and smoking, but not by NOD2/CARD15 genotype.  (Louis E, et al. Gut 2003;52:552-557)

Steroid injection after dilation of anastomotic strictures.  Endoscopic balloon dilation of CD strictures may not result in long-term symptomatic relief.  J. C. Brooker et al. at St. Mark's Hospital (London, UK) retrospectively reviewed 20 cases of endoscopic balloon dilation in 14 CD patients that were followed by triamcinolone injection into the stricture (median dose of 20 mg; range, 10 to 40 mg).  Seven patients (50%) achieved a sustained remission after a single procedure with a median follow-up of 16.4 months.  Four (28.5%) patients required more than one dilation to control symptoms and endoscopic management failed in 3 patients (21.4%).  No untoward side effects were reported.  These results suggest that triamcinolone injection into the stricture after dilation may be a useful procedure in the management of anastomotic CD strictures.  (Brooker JC, et al. Endoscopy 2003;35:333-337)

NEWLY DIAGNOSED COLITIS

Case-control study of association with non-steroidal anti-inflammatory drug (NSAID) use.  M. H. Gleeson and A. J. M. Davis conducted a case-control analysis of 105 consecutive new cases of colitis presenting to a single gastroenterologist.  They found that 78 (74%) patients received NSAIDs prior to or during development of colitis, whereas only 20% and 30% of age- and sex-matched community and hospital controls, respectively, used NSAIDs (p <0.001).  Analysis of these data gave odds ratios of 9.1 with the community controls and 6.2 with the hospital controls.  These findings indicate that NSAIDs may have a role in the initial pathogenesis of colitis.  (Gleeson MH and Davis AJM. Aliment Pharmacol Ther 2003;17:817-825)

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