title: Prognostic factors for long-term infliximab treatment in Crohn's disease patients: a 20-year single centre experience.
abstract: The long-term efficacy of infliximab in patients with Crohn's disease is suboptimal.
  
  
  
  To study prognostic factors for real-life long-term effcacy of infliximab in Crohn's disease.
  
  
  
  All consecutive Crohn's disease patients treated with infliximab at a tertiary centre were retrospectively analysed. Only patients who received scheduled infliximab maintenance treatment were considered. Patient- and disease-related factors were used to identify independent predictors of infliximab failure-free survival using Cox proportional hazards regression.
  
  
  
  Of 1031 patients with Crohn's disease, 261 were eligible for inclusion. Median time on infliximab was 2.4 [IQR 1.4-4.7] years, and 65 (24.9%) patients experienced infliximab failure. Estimated 5-year infliximab failure-free survival was 65.9% (95% CI 58.3-73.5). Multivariate Cox regression identified disease duration ≥1 year (HR 2.5 (95% CI 1.2-5.2), P = 0.02), L1 disease location [HR 2.0 (1.1-3.5), P = 0.02], prior anti-TNF use [HR 2.3 (1.1-4.8), P = 0.03], haemoglobin <13.5 g/dL [HR 2.3 (1.2-4.4), P = 0.02], not using therapeutic drug monitoring [HR 8.0 (4.1-15.6), P = 1 × 10(-9) ], and first dose optimisation within first year [HR 3.7 (2.1-6.6), P = 5 × 10(-6) ] as independent predictors of infliximab failure-free survival. Stratifying patients into risk groups resulted in estimated 3-year infliximab failure-free survival rates ranging from 95.3% (94.2-96.4) to 26.3% (8.6-44.0) depending on the number of risk factors (P = 8 × 10(-13) ).
  
  
  
  This study identified several easy to obtain predictors of infliximab failure in patients with Crohn's disease, and these are in line with previous reports. Those with a high-risk profile for infliximab failure in whom infliximab initiation is considered, should be treated as early as possible making use of therapeutic drug monitoring.
authors: Department of Clinical and Experimental Medicine, Translational Research Center for GastroIntestinal Disorders (TARGID), KU Leuven, Leuven, Belgium.
authors: T
authors: T
authors: Billiet
authors: Department of Clinical and Experimental Medicine, Translational Research Center for GastroIntestinal Disorders (TARGID), KU Leuven, Leuven, Belgium.
authors: I
authors: I
authors: Cleynen
authors: Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
authors: V
authors: V
authors: Ballet
authors: Department of Clinical and Experimental Medicine, Translational Research Center for GastroIntestinal Disorders (TARGID), KU Leuven, Leuven, Belgium.|Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
authors: M
authors: M
authors: Ferrante
authors: Department of Clinical and Experimental Medicine, Translational Research Center for GastroIntestinal Disorders (TARGID), KU Leuven, Leuven, Belgium.|Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
authors: G
authors: G
authors: Van Assche
authors: Laboratory for Therapeutic and Diagnostic Antibodies, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
authors: A
authors: A
authors: Gils
authors: Department of Clinical and Experimental Medicine, Translational Research Center for GastroIntestinal Disorders (TARGID), KU Leuven, Leuven, Belgium.|Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
authors: S
authors: S
authors: Vermeire
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
chemical_list: D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab