Outcome of continued infliximab therapy in Crohn's disease patients with response but without remission after one year of infliximab – a retrospective cohort study. (3rd August 2018)

• Record Type: Journal Article
• Authors: Buhl, Sine; Kristina Borghede, Märta; Brynskov, Jørn; Steenholdt, Casper; Rasmussen, Maria; Andrew Ainsworth, Mark
• Is Part Of: Scandinavian journal of gastroenterology. Volume 53:Number 8(2018)
• Page Start: 930
• Page End: 937
• Publication Date: 2018-08-03
• Subjects: Crohn's disease -- infliximab -- disease outcome -- prognosis -- patient outcomes; Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; 616.33
• DOI: 10.1080/00365521.2018.1481519
• Languages: English
• ISSNs: 0036-5521

Abstract

Abstract: Background: Optimal management of Crohn's disease patients having responded to infliximab but without achieving remission is not well defined. The present study examined if these patients benefit from continued long-term infliximab maintenance therapy. Method: Retrospective cohort study including all patients treated with infliximab for 1 year until the end of 2017 who have had a response but not reached remission on infliximab. Clinical outcomes were defined by the physicians' global evaluation, supported by clinical indices and objective markers of disease activity. Results: In total, 376 Crohn's disease patients received infliximab. Among these, 76 (20%) were classified as having response but non-remission (RNR) after 1 year of therapy. A great majority ( n = 54; 71%) experienced no additional therapeutic benefit after a further year of infliximab maintenance therapy, thus still having RNR. Nineteen patients (25%) obtained remission during continued infliximab, whereas only 4% ( n = 3) experienced treatment failure. Although infliximab therapy beyond 2 years (follow-up median 35 months, IQR: 23–55) was accompanied by a higher proportion attaining remission (40%), nearly half (46%) still failed to improve. Among patients who had discontinued infliximab while having RNR ( n = 21), half ( n = 11) experienced disease flare within five months (median 22 weeks, IQR: 12–31). Conclusion: Most patients (71%) had no additional therapeutic benefit after an additional year of infliximab therapy, and after a median maintenance infliximab treatment period of 3 years, half still failed to improve further. Considering the importance of achieving complete remission, these patients appear to have an unmet medical need.