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Background Patients with the inflammatory bowel diseases ulcerative colitis and Crohn's disease need lifelong treatment and care. Effect of traditional treatments is varied and may cause serious adverse events. Biological drugs aimed at blocking specific molecular steps in the inflammatory process have been developed. Tumor necrosis factor (TNF)α is a proinflammatory cytokine with a role in the inflammatory process associated with inflammatory bowel disease. Hence, a drug blocking this cytokine might be useful for patients with ulcerative colitis and Crohn's disease. This report includes knowledge of the TNFα-inhibitors infliximab (Remicade(r)), adalimumab (Humira(r)), etanercept (Enbrel(r)) and certolizumab pegol (Cimzia(r)). Method We systematically reviewed and critically appraised available documentation on effect and safety of TNFα-inhibitors. In addition, we have reviewed health economic studies. We identified documentation by a systematic search in Cochrane Library, Medline, Embase, PubMed and NHS Economics Evaluation Database. Our evaluation on efficacy and safety was based on systematic reviews. However, to make sure that all available data was included, we searched for randomized controlled trials published afer the literature seach in the systematic reviews was performed. Results In patients with ulcerative colitis, infliximab was more effective than placebo in achieving improvement of the disease. Data on response and remission are available up to 54 weeks. Infliximab gives a higer proportion of patients with endoscopic remission compared to placebo. None of the other TNFα-inhibitors were tested in patients with ulcerative colitis. In patients with Crohn's disease, infliximab, adalimumab and certolizumab were more effective than placebo in achieving response after induction treatment (1-3 administrations of drug or placebo). Based on patients responding to induction treatment, it has been shown that maintenance treatment with infliximab, adalimumab and certolizumab is more effective than placebo in maintaining the initial response. Infliximab has been showed to be more effective than placebo in achieving fistula closure. Data on etanercerpt in treatment of Crohn's disease is limited. There is no basis to claim that etanercerpt has effect in treatment of Crohn's disease. We identified four economic evaluations in a systematic literature search. All studies were from countries outside Norway and dealt with infliximab treatment of patients with Crohn's disease. Conclusion Infliximab is effective in treatment of ulcerative colitis and Crohn's disease. Adalimumab and certolizumab have documented effect in treatment of Crohn's disease, while studies on patients with ulcerative colitis are lacking. There is too limited data available to conclude regarding safety of long-term treatment with TNFα-inhibitors for both ulcerative colitis and Crohn's disease. Based on results from countries outside Norway, infliximab does not seem to be cost-effective as continuous treatment for patients with Crohn's disease. There might be an exception in the case of patients exhibiting good and long-lasting response. No relevant economic studies were found for ulcerative colitis or for the other TNFα-inhibitors.

Tumor necrosis factor. --- Inflammatory bowel diseases --- Anti-inflammatory agents. --- Treatment.

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Fast Facts: Inflammatory Bowel Disease will prove an invaluable resource for all healthcare professionals working with people with IBD and for patients who wish to know more about their condition.

Inflammatory bowel diseases -- Pathophysiology. --- Inflammatory bowel diseases. --- Pathophysiology. --- Inflammatory Bowel Diseases --- Intestinal Diseases --- Gastroenteritis --- Gastrointestinal Diseases --- Digestive System Diseases --- Diseases --- Gastroenterology --- Medicine --- Health & Biological Sciences --- IBD (Disease) --- Inflammatory bowel disease --- Intestines --- Inflammation

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Pediatric Inflammatory Bowel Diseases (IBD) are the most common and most significant chronic disorders in Pediatric Gastroenterology. The onset of Crohn disease and ulcerative colitis in the first two decades of life presents a number of diagnostic and therapeutic challenges that are unique to pediatric patients. Although the studies available for pediatric diagnosis have improved dramatically in the past three decades, the improvement in technology alone cannot account for the increased frequency of IBD recognized in early childhood. While therapy for older patients has improved dramatically with the use of immunomodulators and the development of exciting biologic strategies, rarely if ever have comprehensive studies of the pharmacokinetics, safety and efficacy of any of the IBD medications been performed in pediatric patients. A number of excellent medications are not available in liquid preparations that can be swallowed by children, and others, such as timed-release formulations, are developed for delivery to an adult gastrointestinal tract. It is unfortunate that the care we provide to children is often an extrapolation of what is known about and available for adults with IBD. Pediatric patients with IBD face a number of unique challenges. The onset of disease before puberty can be devastating. Growth failure is a particularly difficult problem with potentially permanent consequences. Much of the pediatric specific research has focused on the role of nutritional therapy to treat growth failure and induce remission.

Inflammatory Bowel Diseases. --- Adolescent. --- Child. --- Infant. --- Inflammatory bowel diseases. --- Children --- Affections intestinales inflammatoires --- Enfants --- Diseases --- Maladies --- Infant --- Inflammatory Bowel Diseases --- Adolescent --- Child --- Age Groups --- Intestinal Diseases --- Gastroenteritis --- Gastrointestinal Diseases --- Persons --- Digestive System Diseases --- Named Groups --- Gastroenterology --- Medicine --- Health & Biological Sciences --- Gastroenteritis. --- EPUB-LIV-FT LIVMEDEC LIVSANTE SPRINGER-B --- Cholera morbus --- Enterogastritis --- Flu, Intestinal --- Flu, Stomach --- Gastrointestinal system --- Intestinal flu --- Stomach flu --- IBD (Disease) --- Inflammatory bowel disease --- Intestines --- Inflammation --- Medicine. --- Internal medicine. --- Gastroenterology. --- Pediatrics. --- Medicine & Public Health. --- Internal Medicine. --- Alimentary canal --- Medicine, Internal --- Paediatrics --- Pediatric medicine --- Internal medicine --- Digestive organs --- Health and hygiene --- Gastroenterology .