Optimizing the use of anti-tumor necrosis factor in the management of patients with Crohn's disease.

Since the approval of the first anti-tumor necrosis factor (anti-TNF) therapy in late 1998, the treatment for Crohn's disease (CD) has been revolutionized. Anti-TNF therapy has been consistently shown in numerous clinical trials to be effective for patients with more aggressive perianal, internal penetrating, and fistulizing CD. However, the loss of clinical remission is frequent and only one-third of patients remain in clinical remission at 1 year. The pharmacokinetics of anti-TNF is highly variable among patients and could be influenced by many factors including serum albumin, gender, body weight, systemic inflammation and route of administration. The main factor impacting anti-TNF pharmacokinetics and efficacy is the development of immunogenicity where antidrug antibodies accelerate anti-TNF drug clearance. In this review paper, we evaluate the role of combination therapy with anti-TNF drugs and immunomodulators, the role of therapeutic drug monitoring, and strategies to recapture loss of clinical response in order to improve both short- and long-term outcomes in CD patients.

Hepatitis C and work impairment: a review of current literature.

Approximately 2.7 to 4.1 million people have chronic hepatitis C (HCV) in the United States. Although often thought of as an asymptomatic disease, several studies have revealed that those with chronic HCV experience increased work impairment manifested as decreased work productivity and increased absenteeism and presenteeism (attending work while being impaired). This review article summarizes the current literature examining the link between chronic HCV and work impairment for those with and without treatment and liver transplant recipients. We searched PubMed for epidemiological studies of HCV and its effect on worker productivity. We used a combination of the keywords "Hepatitis C," "disability," "work," "occupation," "labor," "productivity," and "absenteeism." Multiple studies were identified in our search and all confirmed the hypothesis that chronic HCV infection, with and without active treatment, lead to decreased work productivity and increased absenteeism. This was also found to be true for those who had undergone liver transplantation. Those living with chronic HCV infection experience increased work impairment manifested as decreased work productivity and increased absenteeism. This was found to be true whether or not patients were undergoing active treatment and for liver transplant recipients. Identifying a trend toward increased disability in patients with chronic HCV can help promote appropriate health care, government, and work allocation of resources to help minimize economic, social, and health burdens.