The outcome of infliximab dose doubling in 157 patients with ulcerative colitis after loss of response to infliximab. Issue 10 (10th September 2015)

• Record Type: Journal Article
• Authors: Dumitrescu, G.; Amiot, A.; Seksik, P.; Baudry, C.; Stefanescu, C.; Gagniere, C.; Allez, M.; Cosnes, J.; Bouhnik, Y.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 42:Issue 10(2015)
• Page Start: 1192
• Page End: 1199
• Publication Date: 2015-09-10
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.13393
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" id="apt13393-abs-0001"> <title>Summary</title> <sec id="apt13393-sec-0001" sec-type="section"> <title>Background</title> <p>Optimising infliximab therapy is recommended in inflammatory bowel disease (IBD) patients who lose response to infliximab; however, there are no data on the outcome of ulcerative colitis (UC) patients after doubling the dose.</p> </sec> <sec id="apt13393-sec-0002" sec-type="section"> <title>Aim</title> <p>To determine the efficacy and safety of infliximab dose doubling in UC patients with a loss of response to infliximab.</p> </sec> <sec id="apt13393-sec-0003" sec-type="section"> <title>Methods</title> <p>From January 2006 to May 2013, we retrospectively reviewed the outcome of the consecutive UC patients who were treated with infliximab dose doubling (10 mg/kg) for loss of response in four French academic centres. The clinical response and remission were assessed. A composite event‐free survival analysis was performed using the log‐rank test and the Cox model.</p> </sec> <sec id="apt13393-sec-0004" sec-type="section"> <title>Results</title> <p>One hundred and fifty‐seven patients [84 males; median age 37. 6 (IQR 28.2–49.4) years] were included. The median follow‐up after infliximab dose doubling was 1.8 (1.0–3.1) years. At weeks 8 and 24, 55% and 43% of the patients achieved a clinical response respectively. The probabilities of the event‐free survival were 71%, 61% and 55% at 6 months, 1 year and 2 years respectively. In the multivariate analysis, the predictors of infliximab dose doubling failure were the absence of the introduction of an immunomodulator concomitantly to dose doubling, a partial Ulcerative Colitis Disease Activity Index >6, a C‐reactive protein level >10 mg/L, a leucocyte count >8000/mm<sup>3</sup> and a haemoglobin level <12.5 g/dL. Adverse events were reported in 12 patients (8%).</p> </sec> <sec id="apt13393-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Infliximab dose doubling led to short‐ and long‐term event‐free survival in UC patients, who had a loss of response to infliximab, in greater than 50% of the cases. The benefits of such a strategy were significantly improved by adding a concomitant immunomodulator.</p> </sec> </abstract>