John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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Immunosuppressants and anti-TNF therapy: should they be combined? Volume 16, special issue 1, Maladie de Crohn : vers une « rémission profonde » en 2009

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Pôle des maladies de l’appareil digestif, service de gastroentérologie et assistance nutritive, université Paris-VII, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France

Classical sequential treatment of luminal Crohn’s disease (steroids, then immunosuppressants) is not efficient at altering the natural course of the disease towards parietal complications (fistulas and stenoses). The advent of anti-TNF therapy, with its prompt anti-inflammatory effects, has led to the need to redefine the best treatment strategies: early use of biological therapies, in combination or not with immunosuppressive agents, appropriate duration of the combined treatments, etc. Several important trials, although done with differing methodologies, have suggested management strategies that still need to be validated. Physicians should strive to limit the risks, in particular infectious and maybe also cancerous, associated with these treatments. To use a military metaphor, available therapies are like powerful weapons: they need to be used with accuracy to strike at their intended target while avoiding collateral damages.