Canadian Association of Gastroenterology Clinical Practice Guidelines: The use of tumour necrosis factor-alpha antagonist therapy in Crohn's disease
DC Sadowski | CN Bernstein | A Bitton | K Croitoru | RN Fedorak | A Griffiths | and the CAG Crohn's Consensus Group
BACKGROUND: Guidelines regarding the use of infliximab in Crohn's
disease were previously published by the Canadian Association of
Gastroenterology in 2004. However, recent clinical findings and drug
developments warrant a review and update of these guidelines.
OBJECTIVE: To review and update Canadian guidelines regarding the
use of tumour necrosis factor-alpha antibody therapy in both luminal
and fistulizing Crohn's disease.
METHODS: A consensus group of 25 voting participants developed a
series of recommendation statements that addressed pertinent clinical
questions and gaps in existing knowledge. An iterative voting and feedback
process was used in advance of the consensus meeting in conjunction
with a systematic literature review to refine the voting statements.
These statements were brought to a formal consensus meeting held in
Montreal, Quebec (March 2008), wherein each statement underwent
discussion, reformulation, voting and subsequent revision until group
consensus was obtained (at least 80% agreement).
OUTCOME: The 47 voting statements addressed three themes: induction
therapy, maintenance therapy and safety issues. As a result of the
iterative process, 23 statements achieved consensus and were submitted
CONCLUSION: In the past five years, tumour necrosis factor-alpha
antagonist therapy has become a cornerstone in the management of
moderate-to-severe Crohn's disease refractory to conventional treatment
algorithms. The evidentiary base supporting the use of these drugs
in Crohn's disease is substantial and strengthened by results from longterm
clinical and molecular studies. However, significant gaps in knowledge
exist, particularly with regard to treatment failure. Confidence in
the safety of these drugs is increasing, provided that therapy is administered
in a clinical setting in which potential complications can be readily
recognized and treated.