Predictors of response to infliximab in luminal Crohn's disease
David Laharie1, Mélanie Salzmann, Hamida Boubekeur
1Service d'hépato-gastroentérologie, Hôpital Haut-Lévêque, 33600 Pessac. david.laharie@chu-bordeaux.fr
Insights
Exclusive colonic involvement predicts sustained response to infliximab in Crohn's disease (CD). Initiating immunosuppressive therapy, especially in women, may improve long-term treatment outcomes.
Area of Science:
- Gastroenterology
- Immunology
- Pharmacology
Background:
- Crohn's disease (CD) is a chronic inflammatory bowel disease.
- Infliximab is a biologic therapy used to treat CD.
- Predicting response to infliximab is crucial for optimizing patient care.
Purpose of the Study:
- To identify factors that predict a sustained response to infliximab in patients with luminal Crohn's disease.
- To analyze the impact of disease location and concomitant therapies on treatment outcomes.
Main Methods:
- A cohort of 44 patients with luminal CD treated with infliximab was studied.
- Response was assessed using the Crohn's Disease Activity Index (CDAI) at 2 and 8 weeks.
- Multivariate analysis was used to identify predictive factors for sustained response.
Main Results:
- 88% of patients showed clinical response at 2 weeks, with 79% in remission.
- At 8 weeks, the response rate was 61.4%.
- Exclusive colonic involvement predicted sustained response (P=0.03). Initiating immunosuppressive therapy in women was associated with longer response duration (P=0.017).
Conclusions:
- Exclusive colonic involvement is a key predictor of sustained response to infliximab in luminal CD.
- Initiation or modification of immunosuppressive therapy may enhance sustained response, particularly in female patients.
Aims:
To identify predictive factors of response to infliximab in luminal Crohn's disease (CD).
Patients And Methods:
All consecutive patients with luminal CD treated with infliximab between October 1999 and March 2003 in Bordeaux's referral centers were included. All had at least 3 months follow-up post infliximab infusion and no prior treatment with infliximab. Response rates were determined 2 and 8 weeks after infusion according to Crohn's Disease Activity Index (CDAI) (remission=CDAI<150 and response=CDAI decrease more than 100).
Results:
Among 44 patients (33 female; mean age 35 +/- 14 yr.), 39 (88%) had a clinical response 2 weeks after infusion (79% in remission). At week 8, the rate of response was 61.4% and exclusive colonic involvement predicted sustained response to treatment (P=0.03). The probability of remission at 56 weeks was 21.4%. Multivariate analysis demonstrated that the only factor associated with response duration was initiating immunosuppressive (IS) therapy in women (RR=3.61 95%CI[1.25-10.41], P=0.017).
Conclusion:
Exclusive colonic involvement is the only predictive factor of sustained response to infliximab in luminal CD. At the time of infliximab infusion, initiation or modification of IS therapy may favor sustained response, at least in women.
Related Concept Videos
01:24Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
01:25Inflammatory Bowel Disease III: Crohn's Disease
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the colonic...
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Pharmacologic...