Durability of infliximab in Crohn's disease: a single-center experience. Inflamm Bowel Dis 2009 Dec;15(12):1837-43
Date
05/23/2009Pubmed ID
19462426DOI
10.1002/ibd.20974Scopus ID
2-s2.0-72549114370 (requires institutional sign-in at Scopus site) 20 CitationsAbstract
BACKGROUND: Infliximab is effective maintenance for moderate to severe Crohn's disease (CD); however, problems with immunogenicity and decreased efficacy often complicate long-term use. Durability of infliximab maintenance therapy over multiple years has not been defined.
METHODS: This was a retrospective, observational study of CD patients who received maintenance infliximab for ≥1 year with the intention of ongoing maintenance. Patients were categorized into those who either discontinued treatment or continued maintenance therapy. We examined the impact of demographic, clinical characteristics, and prior episodic exposure on long-term durability of infliximab therapy and also examined the reasons for discontinuation of therapy.
RESULTS: A total of 153 CD patients received maintenance infliximab treatment beyond 1 year and 42 (27%) ultimately discontinued treatment. The mean duration of maintenance treatment at the time of discontinuation was 42.4 ± 19.1 months compared to a follow-up period of 49.4 ± 19.8 months in the cohort continuing therapy (P = 0.049). The main reasons for discontinuation were allergy/adverse reaction (44.2%) and decreased efficacy (38.2%). Use of concomitant immunosuppression was similar between the 2 groups (78.6% versus 83.8%, P = NS). However, the discontinued group had a higher rate of prior episodic dosing compared to CD patients who continued maintenance (28.8% versus 11.7%, P = 0.025), while there was no difference in the rate of intensified dosing (57.2% versus 50.5%, P = NS).
CONCLUSIONS: One-quarter of CD patients on long-term infliximab maintenance discontinued treatment. A history of prior episodic dosing was significantly associated with infliximab discontinuation, despite concomitant immunosuppression. These data emphasize the need for optimization of infliximab for successful long-term management.
Author List
Gonzaga JE, Ananthakrishnan AN, Issa M, Beaulieu DB, Skaros S, Zadvornova Y, Johnson K, Otterson MF, Binion DGAuthor
Mary F. Otterson MS, MD Emeritus Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAntibodies, Monoclonal
Crohn Disease
Female
Gastrointestinal Agents
Humans
Infliximab
Male
Middle Aged
Retrospective Studies
Treatment Outcome
