Infliximab therapy in Crohn's disease: a pragmatic approach?
D Kevans1, D Keegan, H E Mulcahy
1Centre for Colorectal Disease, St Vincent's University Hospital & University College Dublin, Dublin, Ireland.
Alimentary Pharmacology & Therapeutics
|July 18, 2006
Summary
Many Crohn's disease patients can achieve remission with episodic infliximab therapy, reducing the need for continuous maintenance infusions. This approach is effective in managing both luminal and fistulating disease.
Area of Science:
- Gastroenterology
- Immunology
Background:
- Infliximab is a proven treatment for Crohn's disease, but its optimal long-term administration strategy (maintenance vs. episodic) remains debated.
- This study addresses the controversy surrounding infliximab therapy in Crohn's disease, particularly in clinical settings favoring episodic treatment.
Purpose of the Study:
- To evaluate the necessity of maintenance infliximab therapy in Crohn's disease patients.
- To assess the efficacy of episodic infliximab therapy in a cohort utilizing immunomodulatory agents.
Main Methods:
- Ninety-three Crohn's disease patients receiving infliximab were analyzed.
- Data included disease characteristics, treatment history, response rates, and medication use.
Main Results:
- Initial response rates were 78% for luminal and 52% for fistulating Crohn's disease.
- Only 10 of 67 responders transitioned to maintenance infliximab; 31 maintained remission with episodic therapy.
- Factors like disease site and prior surgery influenced response rates, while younger age and small bowel involvement correlated with higher relapse rates.
Conclusions:
- Episodic infliximab regimens can successfully maintain remission in a significant proportion of Crohn's disease patients.
- This suggests that maintenance therapy may not be universally required.
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