title: Scheduled infliximab monotherapy to prevent recurrence of Crohn's disease following ileocolic or ileal resection: a 3-year prospective randomized open trial.
abstract: BACKGROUND
  Infliximab (IFX) is effective for remission induction and maintenance of Crohn's disease (CD). This trial assessed the efficacy of scheduled maintenance IFX monotherapy to prevent postoperative CD recurrence.
  
  
  METHODS
  Thirty-one CD patients who had ileocolic resection within the past 4 weeks were randomly assigned to scheduled IFX at 5 mg/kg intravenously every 8 weeks for 36 months (n = 15) or without IFX (control, n = 16). All patients were treated without immunomodulator or corticosteroid following surgery. The primary and secondary endpoints were remission rates at 12 and 36 months, defined as CD Activity Index (CDAI) ≤150, an International Organization for the Study of Inflammatory Bowel Disease (IOIBD) score <2, and C-reactive protein (CRP) <0.3 mg/dL. Additionally, endoscopic recurrences at 12 and 36 months were evaluated.
  
  
  RESULTS
  At 12 and 36 months, 100%, and 93.3% of patients in the IFX group were in remission (IOIBD <2), respectively vs. 68.8% and 56.3% in the control arm (P < 0.03). Similarly, 86.7% and 86.7% of patients in the IFX group maintained serological remission (CRP <0.3 mg/dL) vs. 37.5% and 37.5% in the control arm (P < 0.02). Further, the IFX group achieved higher endoscopic remission at 12 months, 78.6% vs. 18.8% (P = 0.004). However, in the Kaplan-Meier survival analysis the CDAI scores between the two arms were not significantly different either at 12 or at 36 months. No adverse event (AE) was observed.
  
  
  CONCLUSIONS
  An early intervention with IFX monotherapy should prevent clinical, serological, and endoscopic CD recurrence following ileocolic resection. Thiopurine naivety and eliminating the initial loading dose of IFX might minimize serious AEs.
authors.affiliation: Department of Lower Gastroenterology, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Yoshida
authors.forename: Ken
authors.initials: K
authors.lastname: Fukunaga
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ikeuchi
authors.forename: Koji
authors.initials: K
authors.lastname: Kamikozuru
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Hida
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Ohda
authors.forename: Yoko
authors.initials: Y
authors.lastname: Yokoyama
authors.forename: Masaki
authors.initials: M
authors.lastname: Iimuro
authors.forename: Naohisa
authors.initials: N
authors.lastname: Takeda
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Kato
authors.forename: Risa
authors.initials: R
authors.lastname: Kikuyama
authors.forename: Kazuko
authors.initials: K
authors.lastname: Nagase
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Hori
authors.forename: Shiro
authors.initials: S
authors.lastname: Nakamura
authors.forename: Hiroto
authors.initials: H
authors.lastname: Miwa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsumoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D002648:Child; D003106:Colon / Q000601:surgery*; D003424:Crohn Disease / Q000188:drug therapy* / Q000601:surgery*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012074:Remission Induction; D055502:Secondary Prevention; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D000069285:Infliximab