title: Infliximab dependency is related to decreased surgical rates in adult Crohn's disease patients.
abstract: 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.
authors.affiliation: Gastroenterology Unit, Medical Section, Herlev Hospital, University of Copenhagen, Herlev, Denmark. natalia.pedersen@zeniavej.dk
authors.forename: Natalia
authors.initials: N
authors.lastname: Pedersen
authors.forename: Dana
authors.initials: D
authors.lastname: Duricova
authors.forename: Martin
authors.initials: M
authors.lastname: Lenicek
authors.forename: Margarita
authors.initials: M
authors.lastname: Elkjaer
authors.forename: Martin
authors.initials: M
authors.lastname: Bortlik
authors.forename: Paal Skytt
authors.initials: PS
authors.lastname: Andersen
authors.forename: Libor
authors.initials: L
authors.lastname: Vitek
authors.forename: Bogi
authors.initials: B
authors.lastname: Davidsen
authors.forename: Vibeke
authors.initials: V
authors.lastname: Wewer
authors.forename: Milan
authors.initials: M
authors.lastname: Lukas
authors.forename: Pia
authors.initials: P
authors.lastname: Munkholm
mesh_terms: 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
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab