Infliximab is effective maintenance for moderate to severe Crohn's disease (CD); however, problems with immunogenicity and decreased efficacy often complicate long-term use. Durability of infliximab maintenance therapy over multiple years has not been defined.
This was a retrospective, observational study of CD patients who received maintenance infliximab for ≥1 year with the intention of ongoing maintenance. Patients were categorized into those who either discontinued treatment or continued maintenance therapy. We examined the impact of demographic, clinical characteristics, and prior episodic exposure on long-term durability of infliximab therapy and also examined the reasons for discontinuation of therapy.
A total of 153 CD patients received maintenance infliximab treatment beyond 1 year and 42 (27%) ultimately discontinued treatment. The mean duration of maintenance treatment at the time of discontinuation was 42.4 ± 19.1 months compared to a follow-up period of 49.4 ± 19.8 months in the cohort continuing therapy (P = 0.049). The main reasons for discontinuation were allergy/adverse reaction (44.2%) and decreased efficacy (38.2%). Use of concomitant immunosuppression was similar between the 2 groups (78.6% versus 83.8%, P = NS). However, the discontinued group had a higher rate of prior episodic dosing compared to CD patients who continued maintenance (28.8% versus 11.7%, P = 0.025), while there was no difference in the rate of intensified dosing (57.2% versus 50.5%, P = NS).
One-quarter of CD patients on long-term infliximab maintenance discontinued treatment. A history of prior episodic dosing was significantly associated with infliximab discontinuation, despite concomitant immunosuppression. These data emphasize the need for optimization of infliximab for successful long-term management. Inflamm Bowel Dis 2009
1 Division of Gastroenterology and Hepatology, Pittsburgh, Pennsylvania
2 Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
3 Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
*Reprints: Inflammatory Bowel Disease Center, Scaife Hall - Room 859, University of Pittsburgh School of Medicine, 3550 Terrace St., Pittsburgh, PA 15261
Received 3 March 2009; Accepted 27 March 2009
Published online 21 May 2009 in Wiley Online Library (wileyonlinelibrary.com).
Financial conflicts of interest: Dr. Binion has received honoraria, consulting fees, and research grant support from Centocor. Study supported from a research grant from Centocor, Horsham, PA, to D.G.B. The funding source had no role in data acquisition, analysis, and preparation and review of the article.
The first 2 authors contributed equally to the study.