Infliximab therapy intensification based on endoscopic activity is related to suppress treatment discontinuation in patients with Crohn disease

Abstract

Administering double doses of infliximab or shortening its dosing interval for patients with Crohn disease who experience a loss of response to treatment is an accepted treatment method; however, the effectiveness and appropriate timing of treatment intensification remain unclear. We examined the treatment outcomes of patients with Crohn disease receiving infliximab therapy intensification. Among 430 patients with Crohn disease who were seen at our related facilities from July 2002 to July 2018, 46 patients (30 men and 16 women) who were followed up for diminished infliximab effects for >1 year after therapy intensification were included in this study. The relationship between patient background and continuation of therapy intensification was retrospectively examined through a logistic regression analysis. Among the 46 patients, 67.4% (31 cases) continued therapy intensification for 12 months. The treatment discontinuation rate after 12 months (7.1% vs 43.8%, P = .015) and the C-reactive protein levels at the start of therapy intensification (P = .0050) were significantly lower in the group in which treatment was strengthened due to remaining endoscopic findings (n = 14) than that due to clinical symptoms (n = 32). There was no significant difference in the rates of treatment discontinuation after 12 months of treatment strengthening between patients receiving double doses (n = 34) and those with shortened dosing intervals (n = 12). Infliximab treatment discontinuation seems to be less likely to occur in patients with Crohn disease who are receiving infliximab treatment intensification based on endoscopic findings of exacerbations than in patients whose treatment is based on clinical symptoms.

Dose Escalation Patterns of Advanced Therapies in Crohn’s Disease and Ulcerative Colitis: A Systematic Literature Review

“…€ Studies reporting 10 mg/kg were assumed to have dosing every 8 weeks. Source: [ 21 , 28 – 33 , 35 – 54 , 58 – 76 , 79 , 80 , 82 – 89 , 92 – 104 , 106 , 107 , 109 – 113 , 115 – 126 , 128 – 132 , 198 – 215 ] …”

Treatment escalation and de-escalation decisions in Crohn’s disease: Delphi consensus recommendations from Japan, 2021

“…However, more recent individual studies continue to provide conflicting perspectives. For example, a recent Japanese study of 46 CD patients followed up for 1 year following diminished infliximab effects after therapy intensification found that outcomes were improved in patients who received infliximab treatment intensification based on endoscopic findings of exacerbations to a greater extent than in patients monitored via clinical symptoms [ 110 ]. On the other hand, the recent STARDUST trial compared a treat-to-target strategy involving early endoscopy, regular biomarker and clinical symptom monitoring, with a clinical maintenance strategy in CD patients with moderate-to-severe disease receiving ustekinumab [ 111 ].…”