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Natalizumab for treatment of Crohn disease in adults

Author
Joshua R Korzenik, MD
Section Editor
Paul Rutgeerts, MD, PhD, FRCP
Deputy Editor
Shilpa Grover, MD, MPH

INTRODUCTION

Natalizumab is a humanized monoclonal antibody to alpha-4 integrin that was initially approved for treatment of multiple sclerosis and more recently for Crohn disease [1,2]. It is generally reserved for patients with moderate to severe Crohn disease that is refractory to other forms of medical therapy.

This topic will review the use of natalizumab in the treatment of Crohn disease. Other approaches to the medical management of Crohn disease are discussed elsewhere. (See "Overview of the medical management of mild to moderate Crohn disease in adults" and "Infliximab in Crohn disease" and "Adalimumab for treatment of Crohn disease in adults" and "Certolizumab pegol for treatment of Crohn disease in adults" and "Budesonide in the treatment of inflammatory bowel disease in adults" and "Antibiotics for treatment of inflammatory bowel diseases".)

MECHANISM OF ACTION

Natalizumab blocks leukocyte migration from the blood vessels to sites of inflammation by inhibiting the action of cell adhesion molecules. Cell adhesion molecules represent a heterogeneous group of transmembrane molecules expressed on numerous cell types, including endothelial cells and leukocytes. Cell adhesion molecules promote the transmigration of leukocytes across the endothelial cell. The particular molecule targeted by natalizumab is alpha-4 integrin, which is expressed on all circulating leukocytes except neutrophils.

INDICATIONS AND CONTRAINDICATIONS

Natalizumab is indicated for inducing and maintaining clinical response and remission in adult patients with Crohn disease. Patients being considered for natalizumab must have:

Moderately to severely active Crohn disease

     

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Literature review current through: Nov 2016. | This topic last updated: Tue Jan 06 00:00:00 GMT+00:00 2015.
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