Infliximab dependency is related to decreased surgical rates in adult Crohn's disease patients.
BACKGROUND
Infliximab dependency in children with Crohn's disease (CD) has recently been described and found to be associated with a decreased surgery rate.


OBJECTIVE
To assess infliximab dependency of adult CD patients, evaluate the impact on surgery, and search for possible clinical and genetic predictors.


METHODS
Two hundred and forty-five CD patients treated with infliximab were included from Danish and Czech Crohn Colitis Database (1999-2006). Infliximab response was assessed as immediate outcome, 1 month after infliximab start: complete, partial, and no response. Three months outcome, after last intended infusion: prolonged response (maintenance of complete/partial response), infliximab dependency (relapse requiring repeated infusions to regain complete/partial response or need of infliximab >12 months to sustain response).


RESULTS
Forty-seven percent obtained prolonged response, 29% were infliximab dependent and 24% nonresponders. The cumulative probability of surgery 40 months after infliximab start was 20% in prolonged responders, 23% in infliximab-dependent patients and 76% in nonresponders (P<0.001). The cumulative probability of surgery at 40 months in patients on maintenance versus on demand regime was 33 and 31%, respectively (P=0.63). No relevant clinical or genetic predictors were identified.


CONCLUSIONS
The infliximab dependency response seems to be equivalent to the prolonged response in adult CD patients when comparing surgery rates.
Pedersen
Natalia
N
Gastroenterology Unit, Medical Section, Herlev Hospital, University of Copenhagen, Herlev, Denmark. natalia.pedersen@zeniavej.dk
Duricova
Dana
D
Lenicek
Martin
M
Elkjaer
Margarita
M
Bortlik
Martin
M
Andersen
Paal Skytt
PS
Vitek
Libor
L
Davidsen
Bogi
B
Wewer
Vibeke
V
Lukas
Milan
M
Munkholm
Pia
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D003424:Crohn Disease / Q000188:drug therapy* / Q000235:genetics / Q000601:surgery*; D018153:Czech Republic; D003718:Denmark; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage*; D005838:Genotype; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab