20 responses to “New therapies and new end points in the treatment of Crohn’s Disease”

  1. This article was interesting in that I did not know that we could change the natural history of crohn’s with the new anti-TNFs.

  2. Since it often takes several mos to access a gastroenterologist, when I start someone on an anti-TNf what would be rcommended re followup regarding side effects?

  3. What about other long-term issues with this approach?

  4. I totally agree with Dr. Bressler’s advise of referring Crohn’s patient for gastroenterological consultation. IBD is an ugly disease as it is lifelong and multi-system involvement and if not managed properly and well controlled can be very disabling and even life threatening.
    I do worry about the potential longterm or future (unknown) side effect or complications from using the anti-TNF medications on these patients. It is trading the devil ( prednisone) we know for something unknown.

  5. i agree with Dr Bresslers opinion.I would like some furthur input in to the long term use of anti-TNF,S.

  6. Longterm effects of the anti-TNF medications and coverage are my main questions.The possiblity of changing the natural course of the disease is challenging.
    For sure referring or re-referring a patient that suffers from Crohn’s disease will be my next step.

  7. Given the novelty of anti-TNF drugs, their long term side effects is my main concern, not to mention the associated cost, once again likely secondary to their relatively recent introduction.

  8. Very interesting article. What do these new drugs cost per month?

  9. also concerned with the long term effects of anti-TNF meds, especially in the younger patients who may be on these for many years

  10. It is very exciting to have something that will treat the disease itself ,not just the symptoms.I would like more specific details of the treatment and the possible side effects that we have to watch out for.

  11. cost limits access,
    selection criteria need defining
    long term s/e of cancers concerning, especially young folk

  12. How long does the patient stay on the treatment and what the costs involved? Does it work for ulcerative colitis?

  13. As it stands now in BC pharmacare will only cover anti-TNF agents if prescription is written by Gastroenterologists. In general these medications are very well tolerated – infectious complications are the most relevant problem to consider.
    Brian Bressler

  14. * The major long term issue with this approach is understanding when we can stop these agents. The major drawback about stopping these drugs is antibody formation which means restarting agents may not work and lead to reactions. Currently we don’t have stopping rules but we are trying to understand in what clinical context we can do this.

    * There is no comparison regarding prednisone and anti TNF agents. Prednisone is the most dangerous drug we use for Crohns disease – it is known to increase mortality (TREAT registry). Furthermore it has never been shown that prednisone can improve any important end points (surgeries, hospitalizations, mucosal healing). Anti TNF agents have been around for over a decade with close to 2 million people being on these drugs for Crohns disease. We are not seeing any new safety signals the longer we use these agents.

    * We don’t have good stopping rules yet, we are trying to answer this question.

  15. As long as the treatment is tolerated and working we continue the medications. The cost is approximately 25-30K per year.

    Brian Bressler

  16. No question about healing the bowel and all the potential good. Unfortunately, there are still significant potential side effects such as increased rate of shingles and the myriad of fine print side effects. A definite step in the right direction, but hopefully more research will find meds with even fewer side effects in the future. The price of these drugs is also astronomical.

  17. Agree with all the above, and glad we have moved forward on healing the bowel with ongoing research into end points, managing and recognizing side effects. Can we ever get special authority?

  18. I would like to know the inclusion criteria for patients with crohn’s disease to receive infliximab therapy.

  19. I always refer patient to gastrologist

  20. I have been on different TNF drugs for Crohn’s, and Ankylosing Spondylitis. I was on Remicade/Infliximab 16 years ago (as a tester). It worked really well for both the Crohn’s and Ankylosing Spondylitis for almost six years. I had my life back and was able to return to full time work. From there I went onto Humira and it worked well for three years. Then I went into a major flare and ended up with surgery. From there I have been on two different TNF drugs. One for Crohn’s and Ankylosing Spondylitis that helped the arthritis but did nothing for Crohn’s, so the trail of Orencia was stopped. From there I went on to another trial drug Vedolizumab that worked great for Crohn’s but not Ankylosing Spondylitis. So seeing how it was stopped I again am looking for surgery seeing how I now have a collapsed ielum. I am looking forward to taking another TNF after surgery called Golimumab. I am more than sure that these drugs are better for us than prednisone seeing how I now have osteoprosis due to the years of use of prednisone.

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