Clinical evolution of luminal and perianal Crohn's disease after inducing remission with infliximab: how long should patients be treated?
BACKGROUND
Few data are available regarding the evolution of Crohn's disease after discontinuing a successful course of infliximab.


OBJECTIVE
To evaluate clinical outcome of Crohn's disease after induction of remission with three infliximab infusions (luminal disease) and after maintenance of remission with 1-year course of infliximab every 8 weeks (luminal and perianal).


METHODS
Twenty-three patients with active luminal Crohn's disease who responded to three infusions of infliximab (0, 2, and 6 weeks), and 23 patients with sustained response to infliximab every 8 weeks during 1 year, were included. Patients were followed-up until relapse or for at least 6 months after infliximab discontinuation. Clinical outcomes and factors associated to relapse were evaluated.


RESULTS
In luminal Crohn's disease, a three-infusion infliximab regimen achieved a sustained response in most patients, especially if a complete response occurred at the time of the third infusion. In patients treated for 1-year, infliximab discontinuation was also successful, with a cumulative probability of being free of relapse of 69% at 12 months. In perianal disease, early relapse was the rule after stopping infliximab treatment, with only 34% of patient maintaining remission at 1 year.


CONCLUSIONS
Short regimens of infliximab might be evaluated in patients with luminal Crohn's disease. However, infliximab discontinuation is not recommended in perianal Crohn's disease, because of a high rate of early relapse.
Domènech
E
E
Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain. domenech@ns.hugtip.scs.es
Hinojosa
J
J
Nos
P
P
Garcia-Planella
E
E
Cabré
E
E
Bernal
I
I
Gassull
M A
MA
D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003424:Crohn Disease / Q000188:drug therapy*; D018572:Disease-Free Survival; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab