Infliximab na doença de Crohn: estudo de 800 infusões em 136 doentes

 H. Cardoso*, F. Magro, F. Azevedo, H. Queiroz, A. C. R. Nunes, A. Sousa Machado, F. Tavarela Veloso

 

Resumo

Objectivos: Avaliar a eficácia clínica e os efeitos adversos do infliximab no tratamento a doença de Crohn na prática clínica.

Material e Métodos: Estudo observacional rectrospectivo de 136 doentes com doença de Crohn tratados com infliximab entre Março de 1999 e Outubro de 2005. Os doentes eram 72 do sexo feminino e 64 do sexo masculino, a idade média era de 33,5 (± 11) anos. A resposta clínica foi definida como completa, parcial e ausência de resposta.

Resultados: Foram efectuadas 800 infusões com média de 5,9 (± 6,1) infusões por doente. As indicações para terapêutica com infliximab foram: doença luminal crónica activa em 74, doença fistulizante em 51 e manifestações extraintestinais refractárias em 11 doentes. A resposta completa foi observada em 90 doentes, resposta parcial em 26 e ausência de resposta em 20. A doença luminal apresentou resposta mais elevada que a doença fistulizante (p=0,031). A duração média de follow-up foi 38,1 (± 22,3) meses. Ocorreram efeitos adversos graves em 21 doentes.

Discussão: A terapêutica com infliximab foi eficaz na doença de Crohn luminal crónica activa e penetrante, sendo superior na doença luminal. A ocorrência de efeitos adversos, pouco frequentes mas graves, torna necessária uma vigilância clínica próxima durante e após o tratamento.

 

Summary

Aim: Evaluate the clinical efficacy and adverse events of infliximab in patients with Crohn’s disease in clinical practice.

Material and Methods: Retrospective observational study of 136 patients with Crohn’s disease treated with infliximab between March 1999 and October 2005. The patients were 72 females and 64 males, the mean age was 33.5 (± 11) years. Clinical response was classified as complete, partial and no response.

Results: A total of 800 infusions were done, with a mean of 5.9 (± 6,1) infusions per patient. Indications for infliximab therapy were: chronic active luminal disease in 74, fistulising disease in 51 and refractory extraintestinal manifestations in 11 patients. Complete response was observed in 90 patients, partial response in 26 and no response in 20. Response rates were higher in luminal disease than in fistulising disease (p=0.031). Mean follow-up was 38.1 (± 22.3) months. Serious adverse events occurred in 21 patients.

Discussion: Infliximab therapy was effective for chronic active luminal and penetrating Crohn’s disease; response rates were higher in luminal disease. The occurrence of infrequent but serious adverse events highlights the importance of close clinical monitoring during and after treatment.

 

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*Correspondência:

Helder Cardoso

Serviço de Gastrenterologia

Hospital S. João

Alameda Professor Hernâni Monteiro

4200-319 Porto

Tel.: 916022457

Fax: 225500315

e-mail: hc@sapo.pt

 

Serviço de Gastrenterologia, Hospital de S. João, Faculdade de Medicina do Porto, Porto, Portugal.