Increasing the infliximab dose is beneficial in Crohn's disease patients who responded to a lower dose and relapsed.
BACKGROUND
Relapse after an initial response to infliximab therapy poses a problem for maintenance treatment.


OBJECTIVE
To assess the effects of increasing the infliximab dosage in Crohn's disease (CD) patients who initially responded but flared during maintenance therapy.


METHODS
This was an observational study. Twelve CD patients with both inflammatory and fistulizing manifestations were included. All patients initially responded to 5 mg/kg of infliximab, relapsed during maintenance therapy, and were treated with 10 mg/kg. The Harvey-Bradshaw index, the fistula activity, and steroid use were assessed before and after treatment with the increased dose of infliximab.


RESULTS
The mean Harvey-Bradshaw index score after flare-up during treatment with 5 mg/kg of infliximab was 13.5+/-3.7. Treatment with 10 mg/kg, in a mean of 3.3 infusions, decreased the activity score to a mean of 8.8+/-2.5. Two patients were weaned off prednisone, and a reduced dose was possible in the other steroid-treated patients.


CONCLUSIONS
Increasing the infliximab dose may be beneficial in CD patients who initially responded to therapy, but relapsed during maintenance with the lower dosage.
Menachem
Yoram
Y
Department of Gastroenterology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Avidan
Benjamin
B
Lavy
Alexandra
A
Lang
Alon
A
Bardan
Eytan
E
Fidder
Herma
H
Bar-Meir
Simon
S
Chowers
Yehuda
Y
D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D003424:Crohn Disease / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage*; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab