title: Factors associated with durable response to infliximab in Crohn's disease 5 years and beyond: a multicenter international cohort.
abstract: BACKGROUND
  Infliximab (IFX) has been used for over a decade worldwide. Less is known about the natural history of IFX use beyond a few years and which patients are more likely to sustain benefits.
  
  
  METHODS
  Patients with Crohn's disease (CD) exposed to IFX from Massachusetts General Hospital, Boston, Saint-Antoine Hospital, Paris, and the Swiss IBD Cohort Study were identified through retrospective and prospective data collection, complemented by chart abstraction of electronic medical records. We compared long-term users of IFX (>5 yr of treatment, long-term users of infliximab [LTUI]), with non-LTUI patients to identify prognostic factors.
  
  
  RESULTS
  We pooled data on 1014 patients with CD from 3 different databases, of whom 250 were defined as LTUI. The comparison group comprised 290 patients with CD who discontinued IFX: 48 primary nonresponses, 95 loss of responses, and 147 adverse events. Factors associated with LTUI were colonic involvements and an earlier age at the start of IFX. The prevalence of active smokers and obese patients differed markedly, but inversely, between American and European centers but did not impact outcome. The discontinuation rate was stable around 3% to 6%, each year from years 3 to 10.
  
  
  CONCLUSIONS
  Young age at start of IFX and colonic CD are factors associated with a beneficial long-term use of IFX. After 5 years of IFX, there is still a 3% to 5% discontinuation rate annually. Several factors associated with a good initial response such as nonsmoker and shorter disease duration at IFX initiation do not seem associated with a longer term response.
authors.affiliation: *MGH Crohn's and Colitis Center, Department of Gastroenterology and Hepatology, Massachusetts General Hospital, Boston, Massachusetts; †Department of Gastroenterology, Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Bern, Switzerland; ‡Department of Gastroenterology and Nutrition, Saint-Antoine Hospital, Pierre et Marie Curie-Paris 6 University, Paris, France; §Healthcare Evaluation Unit, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland; ‖Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland; and ¶Department of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Pascal
authors.initials: P
authors.lastname: Juillerat
authors.forename: Harry
authors.initials: H
authors.lastname: Sokol
authors.forename: Florian
authors.initials: F
authors.lastname: Froehlich
authors.forename: Vijay
authors.initials: V
authors.lastname: Yajnik
authors.forename: Laurent
authors.initials: L
authors.lastname: Beaugerie
authors.forename: Matthew
authors.initials: M
authors.lastname: Lucci
authors.forename: Bernard
authors.initials: B
authors.lastname: Burnand
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Macpherson
authors.forename: Jacques
authors.initials: J
authors.lastname: Cosnes
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Korzenik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D016022:Case-Control Studies; D002648:Child; D003424:Crohn Disease / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000069285:Infliximab; D007390:International Agencies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D000069285:Infliximab