title: Intensification of infliximab therapy in Crohn's disease: efficacy and safety.
abstract: BACKGROUND
  The response of Crohn's disease (CD) to infliximab is initially good, although a loss of efficacy is observed over time. Dose escalation has been recommended in such cases.
  
  
  OBJECTIVE
  To study the response to an intensified infliximab regimen in patients with CD; and to evaluate the adverse effects associated with intensification of therapy and identify predictors of loss of response.
  
  
  METHODS
  We performed a retrospective multicenter survey of all patients with CD who had been treated with at least the 3 induction doses of standard infliximab therapy, and for whom treatment had to be intensified due to loss of response. We analyzed the efficacy of the intensified regimen.
  
  
  RESULTS
  Thirty-three patients were included. After the first intensification dose, 79% of patients had a clinical response (33.5% complete response, 45.5% partial response). In the long term, 83%, 69%, 47%, and 29% of patients who had an initial response to the intensification maintained the response at 6, 12, 18, and 36 months, respectively. The loss of efficacy after escalation was 43% per patient-year of follow-up. One patient had an infusion reaction after 36 doses. One patient developed a herpes zoster infection.
  
  
  CONCLUSIONS
  A high proportion of patients whose dose of infliximab is increased due to loss of efficacy respond initially. However, nearly half lose the response after one year. The safety profile of an intensified infliximab regimen is good.
authors.affiliation: Gastroenterology Units of Hospital de Princesa and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain. mariachs2005@gmail.com
authors.lastname: M Chaparro
authors.forename: P
authors.initials: P
authors.lastname: Martínez-Montiel
authors.forename: M
authors.initials: M
authors.lastname: Van Domselaar
authors.forename: F
authors.initials: F
authors.lastname: Bermejo
authors.forename: J L
authors.initials: JL
authors.lastname: Pérez-Calle
authors.forename: B
authors.initials: B
authors.lastname: Casis
authors.forename: A López-San
authors.initials: AL
authors.lastname: Román
authors.forename: A
authors.initials: A
authors.lastname: Algaba
authors.forename: J
authors.initials: J
authors.lastname: Maté
authors.forename: J P
authors.initials: JP
authors.lastname: Gisbert
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab