Appropriateness of therapy for active Crohn's disease: results of a multidisciplinary international expert panel-EPACT II

TitreAppropriateness of therapy for active Crohn's disease: results of a multidisciplinary international expert panel-EPACT II
Publication TypeJournal Article
Year of Publication2009
AuthorsMichetti, P, Stelle, M, Juillerat, P, Gassull, M, Franz, JHeil, Stange, E, Mottet, C, Gonvers, J-J, Pittet, V, Vader, J-P, Froehlich, F, Felley, C
JournalJournal of Crohns and Colitis
Volume3
Issue4
Pagination232-240
DOI10.1016/j.crohns.2009.05.003
ISSN1873-9946
Accession Numberserval:BIB_FD74494588D3
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.

Notes

oai:serval.unil.ch:BIB_FD74494588D3

WOS ID (UT)

Publié

Short TitleAppropriateness of therapy for active Crohn's disease: results of a multidisciplinary international expert panel-EPACT II
Citation Key / SERVAL ID3989
Peer reviewOui

                         

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