Appropriateness of therapy for active Crohn's disease : results of a multidisciplinary international expert panel--EPACT II
JournalArticle (Originalarbeit in einer wissenschaftlichen Zeitschrift)
 
ID 1197866
Author(s) Michetti, Pierre; Stelle, Marc; Juillerat, Pascal; Gassull, Miquel; Heil, Franz Josef; Stange, Eduard; Mottet, Christian; Gonvers, Jean-Jacques; Pittet, Valérie; Vader, John-Paul; Froehlich, Florian; Felley, Christian; EPACT II Study Group
Author(s) at UniBasel Froehlich, Florian
Year 2009
Title Appropriateness of therapy for active Crohn's disease : results of a multidisciplinary international expert panel--EPACT II
Journal Journal of Crohn's and Colitis
Volume 3
Number 4
Pages / Article-Number 232-40
Keywords Crohn's Disease, Therapy, Steroids, Azathioprine, Methotrexate, Anti-TNF, Pegol
Abstract The increasing number of trials testing management strategies for luminal Crohn's disease (CD) has not fitted all the gaps in our knowledge and thus, in clinical. practice, many decisions for CD patients have to be taken without the benefit of high-quality evidence.Methods: A multidisciplinary European expert panel used the RAND Appropriateness Method to develop and rate explicit criteria for the management of individual patients with active, steroid-dependent (ST-D) and steroid-refractory (ST-R) CD.Results: Overall., 296 indications pertaining to mild-to-moderate, severe, ST-D, and ST-R CD were rated. In anti-TNF naive patients, budesonide and prednisone were found to be appropriate for mild-moderate CD, and infliximab (IFX) was appropriate when these had previously failed or had not been tolerated. In patients with a prior successful treatment by IFX, this drug, with or without co-administration of a thiopurine analog, was favoured. Other anti-TNFs were appropriate in the presence of intolerance or resistance to IFX. High-dose steroids, IFX or adlimumab were appropriate in severe active CD. For the 105 indications for ST-D or ST-R disease, the panel considered the thiopurine analogs, methotrexate, IFX, adalimumab, and surgery for limited resection, to be appropriate, depending on the outcome of prior therapies. Anti-TNFs were generally considered appropriate in ST-R.Conclusion: Steroids, including budesonide for mild-to-moderate CD, remain the first-line therapy for active luminal CD. Anti-TNFs, in particular IFX as shown by the amount of available evidence, remain the second-line therapy for most indications. Thiopurine analogs, methotrexate and anti-TNFs are favoured in ST-D patients and ST-R patients. (C) 2009 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.
Publisher Elsevier
ISSN/ISBN 1873-9946
edoc-URL http://edoc.unibas.ch/dok/A6008017
Full Text on edoc No
Digital Object Identifier DOI 10.1016/j.crohns.2009.05.003
PubMed ID http://www.ncbi.nlm.nih.gov/pubmed/21172281
ISI-Number WOS:000272826900003
Document type (ISI) Article
 
   

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