Crohn's disease - infliximab

NICE has recommended that infliximab should be used to treat people with severe Crohn’s disease provided that all three of the following conditions are fulfilled: The person has severe active Crohn's disease. People with severe active Crohn’s disease will be in very poor general heal ...

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NICE has recommended that infliximab should be used to treat people with severe Crohn’s disease provided that all three of the following conditions are fulfilled:

1. The person has severe active Crohn's disease. People with severe active Crohn’s disease will be in very poor general health. They will have severe symptoms of the disease such as weight loss, severe pain and frequent diarrhoea. In addition to symptoms such as these, new fistulas may be developing and the disease may be affecting parts of the body away from the intestines. The doctor can measure the severity of the disease by comparing a patient’s symptoms with a standard checklist that can be used to calculate a severity ‘score’. Two ‘scoring measures’ that are often used are the Crohn’s Disease Activity Index (or CDAI) and the Harvey- Bradshaw Index. Severe active Crohn’s disease would usually have a score of 300 or more on the Crohn’s Disease Activity Index or at least 8 to 9 on the Harvey-Bradshaw Index.
2. Treatment with immunomodulators and corticosteroids has not worked, or has caused side effects that make it impossible or unsafe for the person to take them.
3. Because of the person’s condition, surgery would not be the right form of treatment.

Infliximab treatment can be repeated for someone who matched criteria 1-3 (above) for treatment with infliximab and who responded to the initial treatment but whose condition then got worse. The doctor should explain the likely risks and benefits of repeating the treatment with infliximab before a decision is made about whether to give another round of treatment.

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