Resultado do tratamento da doença de Crohn com anti-fator de necrose tumoral alfa

Autor: Malheiros, Anna Paula Rocha
Jazyk: portugalština
Rok vydání: 2008
Předmět:
Druh dokumentu: Dissertação de Mestrado
Popis: A doença de Crohn é uma inflamação crônica do trato gastrointestinal. O tratamento convencional é muitas vezes desapontador. Apesar da variedade de drogas disponíveis para o tratamento da doença inflamatória intestinal, tais como: salicilatos e seus derivados, corticosteróides, antibióticos e imunossupressores, nenhuma destas mostrou ser totalmente eficaz ou definitiva para o tratamento da doença e seus surtos de exacerbação. Pesquisas têm sido desenvolvidas com o objetivo de apresentar drogas mais efetivas. Dentre estas, destacam-se as drogas biológicas. O infliximabe é um anticorpo monoclonal quimérico anti-fator de necrose tumoral alfa e está indicado na doença de Crohn refratária e fistulizante. O objetivo deste estudo visa avaliar prospectivamente os resultados e efeitos colaterais precoces e tardios do uso do anti-TNF alfa no tratamento de 60 doentes com doença de Crohn, no período de julho de 1999 a dezembro de 2005. Os doentes foram tratados com anti-TNF alfa (infliximabe), na dose de 5mg/kg de peso, aplicado por via endovenosa em intervalos de dois meses. A avaliação foi realizada por protocolo clínico que classificava os quesitos: estado geral, sintomas intestinais e doença perianal em melhor, inalterado e pior, e pelo índice de atividade da doença de Cronh. Os doentes tratados com anti-TNF alfa apresentaram mediana de duração da doença de sete anos, variando de um a 28 anos entre a data do início dos sintomas e a data de início da pesquisa. 34 doentes (56,7%) já haviam sido submetidos a uma ou mais operações abdominais e 38 (63,3%) a operações orificiais. O software utilizado para a realização dos cálculos foi o SPSS® 9.0 for Windows, sendo estatisticamente significantes os testes com p
Crohn´s disease is a chronic inflammatory disorder of the gastrointestinal tract. Conventional treatment is many times disappointing. Besides the great number of available medications to treat inflammatory bowel diseases, such as salicilates and derivatives, corticosteroids, antibiotics and immunosuppressive agents, none of them proved to be totally efficient or the ultimate treatment for inflammatory diseases and their exacerbation. Researches have been carried out to find more effective therapeutic drugs. Among these therapeutics, biologic treatments have been in evidence. Infliximab is a chimeric IgG1 monoclonal antibody against tumor necrosis factor-alpha, and is indicated for refractory luminal and fistulizing Crohns disease. The aim of this study is to prospectively evaluate the outcome, early and late adverse events, in 60 patients diagnosed with Crohn´s disease and treated with infliximab between July 1999 and December 2005. All patients were treated with anti-TNF-alpha (infliximab), 5mg/kg/dose, intravenously, each two months. Patients were clinically evaluated using a protocol that classified the evolution of the health status, intestinal symptoms and perianal disease, as better, worse or unchanged, during the treatment. Crohn´s disease activity index was also evaluated. Patients treated with anti-TNF-alpha presented a median disease duration of seven (range 1-28) years, between the beginning of the disease symptoms and the beginning of the research protocol. Thirty-four patients (56.7%) have been submitted to one or more abdominal surgeries before, and 38 (63.3%) to anal-rectum surgeries. All statistics tests were performed with computer software Statistical Package for the Social Sciences (SPSS® 9.0) for WindowsTM, and p values of less than 0.05 were considered statistically significant. Totals of 225 anti-TNF-alpha doses were administered. The mean doses administered per patient, in a period of approximately five years, were 3.7 (range 1-14) doses. After the initial treatment, 76% of the patients achieved a response. The most frequent indications for anti-TNF-alpha was perianal disease, occurring in 36 patients (60%), and clinical failure to the conventional treatment, happening in 24 patients (40%). After the first dose of anti-TNF-alpha, patients with more than 10 years of treatment and previously submitted to abdominal surgery presented a satisfactory outcome, similar to those with less than 5 years of disease and not submitted to surgery, p
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