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Effects of Infliximab Retreatment After Consecutive Discontinuation of Infliximab and Adalimumab in Refractory Crohn's Disease

Brandse, Johannan F. MD*; Peters, Charlotte P. MD*; Gecse, Krisztina B. MD, PhD*; Eshuis, Emma J. MD PhD*; Jansen, Jeroen M. MD; Tuynman, Hans A. MD; Löwenberg, Mark MD, PhD*; Ponsioen, Cyriel Y. MD, PhD*; van den Brink, Gijs R. MD, PhD*; D'Haens, Geert R. MD, PhD*

doi: 10.1097/01.MIB.0000438248.14218.1d
Original Clinical Articles

Background: Switches between anti–tumor necrosis factor agents in the treatment of Crohn's disease (CD) occur in case of treatment failure, intolerance, or patient preference. No data are currently available on the usefulness of a second infliximab treatment after earlier discontinuation and previous switch to an alternative anti–tumor necrosis factor agent. In this study, we evaluated the clinical benefit of infliximab retreatment in patients with CD after sequential use of both infliximab and adalimumab.

Methods: Twenty-nine patients with CD who had received earlier treatments with sequential infliximab and adalimumab and were then restarted on infliximab were retrieved from a multicenter registry designed for the follow-up of adalimumab treatment for CD. Short-term and sustained effects of infliximab retreatment were evaluated retrospectively by reviewing clinical records. Follow-up was 18 months for all patients.

Results: In 13/29 (45%) patients, infliximab was reintroduced at intensified dosing schedule (>5 mg/kg or <8 wk) for 23/29 (79%) of patients similar to the schedule who were on at time of previous discontinuation. During the second infliximab treatment course, dosing was further intensified in 11 out of 29 (38%) patients. After 18 months 18/29 (62%), patients were still on continued therapy of their second infliximab treatment. Infliximab was discontinued (after a median of 7 mo) in 11 out of 29 patients for loss of response (n = 7 [24%]), intolerance (n = 3 [10%]), or non-compliance (n = 1 [3%]). Use of induction schedule or concomitant immunomodulators were not significantly associated with treatment benefit.

Conclusions: The majority of patients with CD benefit from a second treatment with infliximab after previous treatment with infliximab and adalimumab, which offer a meaningful therapeutic option in often highly refractory patients.

Article first published online 27 December 2013

*Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands;

Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands; and

Department of Gastroenterology and Hepatology, Medisch Centrum Alkmaar, North Holland, The Netherlands.

Reprints: Geert D'Haens, MD, PhD, Department of Gastroenterology and Hepatology, C2-112, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands (e-mail:

For this article no industry was involved, however, the authors have the following conflicts of interest to disclose: J.F. Brandse had served as a speaker for Tramedico, MSD, Ferring and Takeda. C.P. Peters has nothing to declare; K.B. Gecse has nothing to declare; E.J. Eshuis has nothing to declare; J.M. Jansen has served as a speaker for MSD en Abbott and has served as a consultant for Ferring Pharmaceuticals, Schering Plough, Abbvie, and Pfizer; H.A.R.E. Tuynman has nothing to declare; M. Lö;wenberg has served as speaker for Abbott, Dr. Falk, Ferring, MSD and Tramedico. C.Y. Ponsioen has served as a speaker for Schering Plough, Falk Pharma, Tramedico, Abbott Inc., and Glaxo Smith Kline, a consultant for Schering Plough, Falk Pharma, Tramedico, Abbott Inc., and Glaxo Smith Kline, and has received research funding from Schering Plough, Falk Pharma, Tramedico, Abbott Inc., and Glaxo Smith Kline. G. van den Brink has received consulting fees from Abbott laboratories and lecture fees from Abbott laboratories, Merck Sharp & Dohme and Ferring Pharmaceuticals. He has received research grants from Abbott laboratories, Crucell and Ferring Pharmaceuticals. G.R.A.M. D'Haens has served as a speaker for Abbott Inc, Tillotts, Tramedico, Ferring, MSD, UCB, Norgine, Shire, a consultant for Abbott Laboratories, Actogenix, Centocor, Cosmo, Engene, Ferring Pharmaceuticals, GlaxoSmithKline, Jansen Biologics, Millenium Pharmaceuticals, MSD, Novonordisk, PDL Biopharma, Pfizer, SetPoint, Shire, Takeda, Teva, UCB, and has received research funding from Abbott Inc, Jansen Biologics, Given Imaging, MSD, DrFalk Pharma, Photopill.

This survey is an investigator-initiated study.

Received October 25, 2013

Accepted November 1, 2013

© Crohn's & Colitis Foundation of America, Inc.
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