title: eHealth: individualisation of infliximab treatment and disease course via a self-managed web-based solution in Crohn’s disease.
abstract: BACKGROUND
  Infliximab (IFX) maintenance therapy for Crohn's disease (CD) is administered every 8 weeks, but inter-patient variation in optimal treatment intervals may exist.
  
  
  OBJECTIVE
  To assess, in a prospective pilot study, the efficacy, safety and quality of life (QoL) of IFX maintenance treatment scheduled through web-based self-monitoring of disease activity.
  
  
  METHODS
  Twenty-seven CD patients in IFX maintenance therapy were enrolled and received a standardised disease education and web-training. Using the http://www.cd.constant-care.dk concept, patients recorded their disease activity and faecal calprotectin weekly. From this, the inflammatory burden (IB) score was calculated, placing patients in the green, yellow or red zones of a ‘traffic light’ system. If placed in the yellow or red zones, the computer directed these patients to consult their physician for IFX infusion.
  
  
  RESULTS
  Seventeen patients (63%) completed 52 weeks of follow-up, 6 (22%) completed 26 weeks and 4 (15%) were excluded due to loss of response, patient decision or non-adherence. In total, 121 IFX infusions were given with a median interval of 9 (range: 4–18) weeks. Only 10% of infusions were given at 8-week intervals, whereas 39% were administered with shorter and 50% with longer intervals respectively. The mean IB and the QoL remained stable during the web-treatment. One mild infusion reaction and one case of folliculitis were observed, while three patients underwent surgery.
  
  
  CONCLUSIONS
  The program http://www.cd.constant-care.dk appears to be a practical and safe concept for the individualised scheduling of maintenance treatment with IFX in patients with Crohn's disease. Larger studies are awaited to confirm this preliminary outcome.
authors.affiliation: Gastroenterology Unit, Epidemiology Section, Herlev University Hospital, Copenhagen, Denmark.
authors.forename: N
authors.initials: N
authors.lastname: Pedersen
authors.forename: M
authors.initials: M
authors.lastname: Elkjaer
authors.forename: D
authors.initials: D
authors.lastname: Duricova
authors.forename: J
authors.initials: J
authors.lastname: Burisch
authors.forename: C
authors.initials: C
authors.lastname: Dobrzanski
authors.forename: N N
authors.initials: NN
authors.lastname: Andersen
authors.forename: T
authors.initials: T
authors.lastname: Jess
authors.forename: F
authors.initials: F
authors.lastname: Bendtsen
authors.forename: E
authors.initials: E
authors.lastname: Langholz
authors.forename: S
authors.initials: S
authors.lastname: Leotta
authors.forename: T
authors.initials: T
authors.lastname: Knudsen
authors.forename: N
authors.initials: N
authors.lastname: Thorsgaard
authors.forename: P
authors.initials: P
authors.lastname: Munkholm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D003424:Crohn Disease / Q000188:drug therapy*; D003718:Denmark; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D000069285:Infliximab; D020407:Internet; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010865:Pilot Projects; D011446:Prospective Studies; D012646:Self Administration / Q000379:methods / Q000523:psychology; D012648:Self Care / Q000379:methods / Q000523:psychology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D017216:Telemedicine; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab