Appropriate maintenance treatment for Crohn's disease: results of a multidisciplinary international expert panel - EPACT II

Détails

ID Serval
serval:BIB_DA2C4DCF3F26
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Appropriate maintenance treatment for Crohn's disease: results of a multidisciplinary international expert panel - EPACT II
Périodique
Journal of Crohns and Colitis
Auteur(s)
Juillerat Pascal, Vader John-Paul, Felley Christian, Pittet Valérie, Gonvers Jean-Jacques, Mottet Christian, Bemelman Willem A., Lemann Marc, Oresland Tom, Michetti Pierre, Froehlich Florian
Collaborateur(s)
Grp. E. P. A. C. T. I. I. Study
ISSN
1873-9946
Statut éditorial
Publié
Date de publication
2009
Peer-reviewed
Oui
Volume
3
Numéro
4
Pages
241-249
Langue
anglais
Résumé
Introduction: Biological. therapy has dramatically changed management of Crohn's disease (CD). New data have confirmed the benefit and relative long-term safety of anti-TNF alpha inhibition as part of a regular scheduled administration programme. The EPACT appropriateness criteria for maintenance treatment after medically-induced remission (MIR) or surgically-induced remission (SIR) of CD thus required updating. Methods: A multidisciplinary international expert panel (EPACT II, Geneva, Switzerland) discussed and anonymously rated detailed, explicit clinical indications based on evidence in the literature and personal expertise. Median ratings (on a 9-point scale) were stratified into three assessment categories: appropriate (7-9), uncertain (4-6 and/or disagreement) and inappropriate (1-3). Experts ranked appropriate medication according to their own clinical practice, without any consideration of cost. Results: Three hundred and ninety-two specific indications for maintenance treatment of CD were rated (200 for MIR and 192 for SIR). Azathioprine, methotrexate and/or anti-TNF alpha antibodies were considered appropriate in 42 indications, corresponding to 68% of all appropriate interventions (97% of MIR and 39% of SIR). The remaining appropriate interventions consisted of mesalazine and a "wait-and-see" strategy. Factors that influenced the panel's voting were patient characteristics and outcome of previous treatment. Results favour use of anti-TNF alpha agents after failure of any immunosuppressive therapy, while earlier primary use remains controversial. Conclusion: Detailed explicit appropriateness criteria (EPACT) have been updated for maintenance treatment of CD. New expert recommendations for use of the classic immunosuppressors as well as anti-TNF alpha agents are now freely available online (www.epact.ch). The validity of these criteria should now be tested by prospective evaluation. (C) 2009 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.
Mots-clé
Crohn's disease, Therapy, Maintenance treatment, Appropriateness, RAND Appropriateness Method, Inflammatory bowel disease, Inflammatory-Bowel-Disease, Medically Induced Remission, T-Cell Lymphoma, Postoperative Recurrence, Randomized-Trial, Certolizumab Pegol, Double-Blind, Infliximab, Therapy, Prevention
Web of science
Open Access
Oui
Création de la notice
06/01/2010 11:32
Dernière modification de la notice
09/05/2019 2:03
Données d'usage