Infliximab Supply Chain Management

Management and Treatment

General management includes nutritional assessment and support as well as advice on smoking cessation. A big emphasis is placed on diet control and avoiding certain food groups including dairy, yeast and gluten. Eating smaller portions, as well as restricting the amount of carbohydrates and high fibre food consumed has been associated with an improvement in symptoms . Furthermore, an elemental diet containing essential amino acids, vitamins, fats and sugars can be recommended for effective symptomatic control . Its liquid nature means the GI tract does not have to work hard to digest the contents, this allows the bowel to rest and can promote the growth of beneficial bacteria . Other lifestyle advice includes smoking

One of the risks associated with anti-TNF treatment is the reactivation of tuberculosis therefore, prior to commencing treatment of infliximab or adalimumab a chest x-ray and a negative purified protein derivative is required. Despite, this potential adverse effect, anti-TNF treatments have transformed the way severe disease activity is treated. Whilst, anti-TNF therapy is associated with inducing and maintaining mucosal healing, the cost of the treatment means it is not considered as a maintenance therapy. This is a point of contention, as studies have shown there is a 15% reduction in hospitalisation when infliximab is used as a maintenance treatment . Therefore, patients could benefit greatly from this therapeutic

However, it is worth noting that the evidence of the effectiveness of anti-TNFs agents remains limited, as only a small number of studies have been undertaken showing the long-term effect of treatment. Furthermore, the cost of infliximab remains high and therefore under current UK guidelines it is not offered as a maintenance therapy for any patient with mild or moderate disease activity. In addition, although anti-TNF agents are effective they are limited as a number of patients fail to respond to treatment. Therefore, it is likely that a combination therapy will be most effective in the long-term maintenance of Crohns disease.

However, advancements continue to be made in Crohns disease treatment. Recently, European and United States regulatory bodies have reviewed vedolizumab injection as a new treatment specifically aimed at decreasing an intergerin receptor expressed on inflammatory cells. We may in the future see this treatment option offered in the United Kingdom as phase three trials of the drug have shown it to be 60% more effective than infliximab in inducing remission