At present, biologic agents – like grams are increasingly used in the treatment of Crohn’s disease in major hospitals across the country, and perhaps many patients are not unfamiliar with it. Here again, a brief description of this drug is provided.
Approved in Europe for use in adults with CD (including fistula CD), adolescents with CD and adults with UC. is a first-line anti-TNF biologic available for CD and UC.
Has a sufficient clinical basis.
Induces rapid response and maintains long-term clinical remission after hormone withdrawal in CD and UC.
Improves long-term prognosis (reduced hospitalization and surgery rates) in patients with CD and UC.
Promotes complete mucosal healing in patients with CD and UC.
The indications are described below.
1. Hormones may have short-term effectiveness in patients with inflammatory bowel disease, but they may bring numerous complications. Therefore, to avoid long-term hormone therapy and to minimize the use of hormones, biologic therapy (gram-like) is the best alternative.
2. The clinical characteristics of the patient can be used to assess the suitability of treatment with gram-like or immunosuppressive therapy early in the course of the disease (e.g. smoking, young patients, extensive small bowel lesions, perianal lesions, stenotic lesions).
3. Fibrotic stenotic CD, without active inflammation and without elevated CRP, is not suitable for classical gram therapy. If the stenosis is inflammatory, the outcome may be good, but if there is dilatation of the anterior intestinal canal in the stenotic segment, it is unlikely that the stenotic portion can be reversed by drug therapy. Therefore, for patients with stenosis, clinical evaluation of the inflammatory activity is essential.
4. Any patient with an infection (tuberculosis, hepatitis, any bacterial or viral infection) or vaccination within the last three months should not receive classical gram treatment.
5. Any patient with a history of neoplastic or lymphoproliferative disease, severe congestive heart failure, or neurodemyelinating lesions should not be treated with analogs.
6. Patients with hormone-dependent, hormone-resistant, and/or immunosuppressant-resistant inflammatory bowel disease, as well as patients who are intolerant to these conventional drugs, may be started on biologic therapy (gram-like).
7.Perianal abscesses are drained first and then treated with classical grams, and complex anal fistulas can achieve excellent results with biologic therapy (classical grams) combined with surgical drainage.
8.Patients with effective induction of remission with classical grams should consider regular injections to maintain remission, which is more effective than intermittent use.
9, Patients with elevated CRP have better efficacy in obtaining and maintaining remission with classical grams compared to those with normal CRP.
10. Patients with early intestinal luminal lesions respond better to analogs than those with longer disease duration. In particular, those with endoscopically visible ileal or colonic ulcers are more suitable for treatment with analogues than those with stenotic types.
11. For patients with moderate to severe intraluminal lesions for whom induction of remission with analogs is effective, transition to oral immunosuppressive therapy may have a higher rate of clinical recurrence compared to patients receiving regular analogs.
12. The injection interval may be shortened or the dose may be doubled if the efficacy of the analogues is diminished.
13. Patients who maintain stable remission for up to one year may be considered for discontinuation of analogues.
In the past, the best drugs are used until the last minute, but now a large number of clinical studies have proved that early use of biological therapy can even reverse the course of the disease, reduce the chances of surgery and greatly improve the quality of life. The treatment plan should be individualized for each patient, and the choice of biologic therapy should be based on the patient’s indication, clinical response, quality of life and economic status.