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Vol. 66, No. 4 2015
Northeast Florida Medicine
DCMS online
. org
Inflammatory Bowel Disease
There are no controlled trials evaluating the efficacy of the
anti-TNF agents in PSC. Although PSC may represent an
immune-mediateddisorder, the immunomodulators have not
seemed to alter the disease progression. One uncontrolled
report suggested that infliximab may improve liver injury in
patients with PSC, but there is no data to suggest it changes
bile duct anatomy or histologic improvement within the
liver.
10
Whether infliximab alters the natural course of PSC
remains unstudied at this time.
Summary of the Biologics
There is a significant body of evidence in favor of infliximab
and adalimumab in the treatments of IBD and its extraint-
estinal manifestations. It also implies that the pathogenesis
of intestinal and extraintestinal inflammation in IBD share
a commonTNF- alpha dependent mechanism. TNF- alpha
is more likely an essential proinflammatory mediator of a
systemic immune response and, thus, its inhibition by these
agents could at least partially explain the observed whole
body benefits of these drugs in IBD. The introduction of
the anti-TNF neutralizing antibodies in clinical practice in
the last 18 years has proved to be one of the most signifi-
cant advances in the care of IBD patients. The successes of
these TNF alpha inhibitors have become the inspirational
model for numerous other targeted biologic agents (e.g.
anti-integrins, JAK inhibitors) that are now available in our
armamentarium to treat these aggressive diseases.
20
Conclusion
With the high prevalence of extraintestinal manifestations
and complications in inflammatory bowel disease, which in
some cases aremore incapacitating than the intestinal disease
itself, IBD is truly a systemic disease. As nearly every organ
can be affected by extraintestinal manifestations of IBD, early
recognition and adequate treatment is necessary to prevent
severe morbidity and mortality. In the extraintestinal disor-
ders that follow intestinal activity, such as erythema nodosum
or the type 1 arthropathies, treatment of the underlying
intestinal disease is often sufficient for rapid relief of symp-
toms. In the disease independent manifestations, different
strategies are clearly needed to optimize the treatment and
management. These extraintestinal complications should
be assessed in patients with inflammatory bowel disease on
a regular basis, as prevention and specific treatments may
have a major benefit on quality of life.
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