Smoking and immunomodulators do not influence the response or duration of response to infliximab in Crohn's disease.
OBJECTIVE
Clinical predictors for infliximab response are still unknown. Identifying predictors of response to infliximab in Crohn's disease may improve our selection of patients.


METHODS
Two hundred patients with luminal (61%) or fistulous (39%) Crohn's disease and at least 6 months of follow-up following a total of 416 infliximab infusions were evaluated. Clinical response and duration of response were the primary endpoints.


RESULTS
Patients with fistulous disease had a higher response rate (83% versus 70%, P = 0.044) and a significantly longer duration of response compared with patients with luminal disease (17.4 versus 10.1 wks, P = 0.017). For luminal disease, nonsmokers and smokers had similar response rates (74% versus 64%, P = 0.5) and similar durations of response (9.4 wks versus 8.4 wks P = 0.6) while patients taking concurrent immunomodulators had similar response rates compared with those not taking immunomodulators (74% versus 71%, P = 0.9) and similar durations of response (10.4 wks versus 10.6 wks, P = 0.9). For fistulous disease, response rates (89% versus 83% P = 0.9) and duration of response (16.9 wks versus 10.1 wks, P = 0.10) were similar between nonsmokers and smokers and concurrent immunomodulators had no effect on response (89% versus 86%, P = 0.9) or duration of response (19.8 wks versus 15.4 wks, P = 0.46). Multivariable analysis confirmed that neither smoking, corticosteroids, immunomodulator therapy, gender, age, age of disease onset, disease duration, nor luminal disease location significantly influenced response or duration of response.


CONCLUSIONS
Patients with fistulous disease had a higher response rate and a significantly longer duration of response compared with patients with luminal disease. However, among patients with luminal or fistulous disease, neither smoking nor immunomodulators had any effect on response or duration of response.
Fefferman
David S
DS
Divisions of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Lodhavia
Parag J
PJ
Alsahli
Mazen
M
Falchuk
Kenneth R
KR
Peppercorn
Mark A
MA
Shah
Samir A
SA
Farrell
Richard J
RJ
D000276:Adjuvants, Immunologic / Q000494:pharmacology* / Q000627:therapeutic use; D000328:Adult; D000911:Antibodies, Monoclonal / Q000493:pharmacokinetics / Q000494:pharmacology*; D003424:Crohn Disease / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005402:Fistula / Q000188:drug therapy* / Q000473:pathology; D005765:Gastrointestinal Agents / Q000493:pharmacokinetics / Q000494:pharmacology*; D006801:Humans; D000069285:Infliximab; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha
D000276:Adjuvants, Immunologic; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab