Clinical use of Infliximab in Crohn's disease: the Edinburgh experience.
Infliximab is an established treatment for steroid-resistant and fistulating Crohn's disease. Although efficacy has been shown in clinical trials, financial implications often limit its use and limited data exist regarding clinical practice.


OBJECTIVE
To audit the clinical effectiveness of Infliximab.


METHODS
We prospectively audited 50 consecutive patients [28 females; median age, 34 years (17-70 years)]. Disease activity and response rates were assessed by the Harvey-Bradshaw index. Clinical and disease data were collected and blood was taken for inflammatory markers, complement and double-stranded DNA antibodies. Patients received Infliximab at 5 mg/kg and were followed for 12 weeks.


RESULTS
Indications for Infliximab were refractory Crohn's disease in 39 patients, fistulating Crohn's disease in six, pyoderma gangrenosum in one, pouchitis in two and coeliac disease in two. Thirty-one (79%) of the refractory Crohn's disease patients and four (66%) of the fistulating patients responded at 4 weeks. Twenty-one (54%) of the refractory Crohn's disease patients had a continued response at 12 weeks. Perianal disease was more prevalent in non-responders (7/8 vs. 12/31, P < 0.02).


CONCLUSIONS
Response rates to Infliximab in our group are comparable to those of clinical trials. Despite the expense, it remains a useful adjunct to treatment in this otherwise difficult group of patients. Patients with perianal disease responded less well in our cohort.
Arnott
I D
ID
Gastrointestinal Unit, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK. iarnott@ed.ac.uk
McDonald
D
D
Williams
A
A
Ghosh
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers; D002446:Celiac Disease / Q000188:drug therapy; D015331:Cohort Studies; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D007412:Intestinal Fistula / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D019449:Pouchitis / Q000175:diagnosis / Q000188:drug therapy; D011379:Prognosis; D011446:Prospective Studies; D017511:Pyoderma Gangrenosum / Q000175:diagnosis / Q000188:drug therapy; D013256:Steroids; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D015415:Biomarkers; D005765:Gastrointestinal Agents; D013256:Steroids; D000069285:Infliximab