Biologic therapy of crohn's disease: Infliximab

Infliximab is a chimeric monoclonal antibody targeting tumor necrosis factor α (TNF- α). It is the first biological agent developed and marketed around the world to treat Crohn's disease and has also been highly efficacious for the treatment of other immune-mediated inflammatory disorders including rheumatoid arthritis, spondyloarthropathies, psoriasis, and ulcerative colitis. Infliximab has been highly efficacious for the treatment of refractory Crohn's disease and has had demonstrated effects on symptoms, signs, mucosal healing, and fistulization such that successful treatment has reduced the number of surgeries and hospitalizations. By virtue of the impact on TNF- a the safety profile f infliximab includes an increased risk of infections, in particular infections by intracellular pathogens, as well as an increased production of autoantibodies. There is also an association with neoplasia, particularly associated with combination therapy with other immunosuppressives. This chapter will outline the proposed mechanisms of action, clinical efficacy, and side effects of infliximab therapy in Crohn's disease.