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Recommendations for the treatment of Crohn's disease with tumor necrosis factor antagonists: An expert consensus report

Feagan, Brian G. MD1,*; Lémann, Marc MD2; Befrits, Ragnar MD, PhD3; Connell, William MD4; D'Haens, Geert MD, PhD5; Ghosh, Subrata MD6; Michetti, Pierre MD7; Ochsenkühn, Thomas MD8; Panaccione, Remo MD6; Schreiber, Stefan MD9; Silverberg, Mark MD, PhD10; Sorrentino, Dario MD11; van der Woude, Janneke C. MD, PhD12; Vermeire, Severine MD, PhD13; Rutgeerts, Paul MD, PhD14

doi: 10.1002/ibd.21870
Consensus Reports

Background: Symptom relief is the traditional treatment goal in Crohn's disease (CD). New goals including mucosal healing and bowel preservation are now achievable with tumor necrosis factor (TNF) antagonists. Infliximab and adalimumab are approved as second-line treatments for severe, active CD. Certolizumab pegol is approved only in the U.S. and Switzerland as second-line treatment for moderate-to-severe, active CD. Data from trials of infliximab suggest that high-risk patients and patients with active inflammation (CRP elevation and/or ileocolonic ulcers) may benefit from earlier use of this drug.

Methods: A Delphi survey was used to obtain consensus on issues surrounding bowel preservation and use of TNF antagonists. At the time of this survey, infliximab was the only TNF antagonist approved for the treatment of CD in Europe, Canada, and Australia. An expert panel of 12 gastroenterologists with substantial clinical experience using infliximab in clinical practice and trials in these areas participated.

Results: The experts agreed that bowel preservation and mucosal healing are relevant and achievable goals, and form a rationale for using TNF antagonists in CD patients. Control of inflammation and induction of mucosal healing were considered essential for bowel preservation. Consensus areas: 1) mucosal healing is predictive of improved long-term disease course and increases the likelihood of steroid-free remission; 2) infliximab induces sustained mucosal healing, promotes bowel preservation, and reduces hospitalizations and surgeries; 3) benefits of infliximab in relation to mucosal healing, bowel preservation, and clinical remission increase when therapy is initiated earlier.

Conclusions: Treatment with TNF antagonists helps preserve the bowel in CD patients. (Inflamm Bowel Dis 2011;)

1 Robarts Research Institute, University of Western Ontario, London, Ontario, Canada

2 Hôpital St. Louis, GI Unit, Paris, France

3 Karolinska Hospital, Department of Gastroenterology and Hepatology, Stockholm, Sweden

4 St. Vincent's Health, Melbourne, Australia

5 Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands

6 Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Canada

7 Division de Gastro-entérologie et Hépatologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

8 Klinikum Grosshadern, Universität München, Innere Medizin/Gastroenterologie, Munich, Germany

9 Christian-Albrechts-University, University of Kiel, Kiel, Germany

10 Mount Sinai Hospital IBD Centre, Toronto, Ontario, Canada

11 University of Queensland at Nambour, Australia, and Department of Experimental and Clinical Medicine, University of Udine, Udine, Italy

12 Erasmus MC, Rotterdam, The Netherlands

13 University Hospital Gathuisberg, Department of Gastroenterology, Leuven, Belgium

14 University of Leuven, Leuven, Belgium

* Professor of Medicine, Epidemiology and Biostatistics, Robarts Research Institute, London, Ontario, Canada N6A 5K8


Received 25 July 2011; Accepted 1 August 2011

Published online 29 October 2011 in Wiley Online Library (


© Crohn's & Colitis Foundation of America, Inc.
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