title: Time of infliximab therapy initiation and dose escalation in Crohn's disease.
abstract: OBJECTIVE
  To determine if early initiation of anti-tumor necrosis factor therapy affects the need for dose escalation.
  
  
  METHODS
  This was a retrospective review of patients receiving infliximab therapy for Crohn's disease (CD) at two outpatient gastroenterology clinics during July 2009 to October 2010. All patients included in the study were biologic agent naïve and had moderate to severe CD (Harvey Bradshaw index > 8). Patients were divided into groups based on length of time between diagnosis to therapy initiation and concurrent immunosuppressant therapy. Kaplan-Meier survival analysis was used to compare the time to dose escalation for the four groups.
  
  
  RESULTS
  There were 68 patients, 51% female and 49% male, with an average age at diagnosis of 24.7 ± 11.9 years. The average age at infliximab initiation was 34.8 ± 14.8 years. Of the 68 patients, 19% initiated inflixiamb within 2 years of diagnosis, and 51% had concurrent immunosuppressant therapy at the time of therapy initiation. Fifty percent of patients required dose escalation and the median time from therapy initiation to dose escalation was 10 mo (interquartile range: 5.3-14.8). There was a statistically significant higher probability of requiring dose esclataion in patients who initiated biologic therapy within 2 years of diagnosis, without concurrent immunosuppressant therapy (P < 0.01).
  
  
  CONCLUSIONS
  Those who receive infliximab within 2 years of CD diagnosis require more intense immunosuppressant therapy than those who received infliximab later.
authors.affiliation: Mindy CW Lam, Kenneth Atkinson, Brian Bressler, Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC V6Z 2K5, Canada.
authors.forename: Mindy C W
authors.initials: MC
authors.lastname: Lam
authors.affiliation: Mindy CW Lam, Kenneth Atkinson, Brian Bressler, Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC V6Z 2K5, Canada.
authors.forename: Terry
authors.initials: T
authors.lastname: Lee
authors.affiliation: Mindy CW Lam, Kenneth Atkinson, Brian Bressler, Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC V6Z 2K5, Canada.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Atkinson
authors.affiliation: Mindy CW Lam, Kenneth Atkinson, Brian Bressler, Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC V6Z 2K5, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Bressler
mesh_terms: D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D001955:British Columbia; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D000069285:Infliximab; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000378:metabolism; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab
keywords: Crohn’s disease; Dose escalation; Infliximab