Introduction Biologics are increasingly used in the management of Crohn’s disease (CD). NICE guidelines advise reassessing CD patients after 12 months of treatment with infliximab and discontinuing therapy for patients in stable clinical remission. Evidence suggests that sustained remission may be achieved in up to 50–60% of these patients on withdrawal of treatment. However, it is recognised that decisions regarding continuing treatment must be individualised and take into account previous disease behaviour. We sought to determine how often in clinical practise maintenance infliximab was discontinued due to clinical remission.
Methods All patients treated with infliximab for CD between September 2006 and December 2012 were identified from our inflammatory bowel disease (IBD) database. Dates of initiation and termination of treatment were recorded along with the reason for discontinuation. Patients continuing on infliximab were analysed in more detail. Patient demographics, past medical history, Montreal classification, baseline investigations, Harvey-Bradshaw index (HBI) and faecal calprotectin (FC) levels were recorded.
Results 114 patients were identified. 11 patients transferred care and were excluded. 91/103 (88.3%) received maintenance (>6 weeks) treatment. 47.3% had discontinued treatment while 52.7% remained on treatment. The median length of treatment was 73 (range 8–329) weeks. Only 23.3% (10/43) discontinued infliximab due to clinical remision with 34.9% (15/43) stopping because of complications and 39.5% (17/43) due to loss of response, surgery or death. The median course of treatment for those continuing on infliximab was 101 (range 8–329) weeks. 37 patients (21 female, mean age 40 years) were on maintenance infliximab treatment for over 1 year. 73% of these patients were on combined treatment with an immunomodulator and 37.8% (14/37) had required dose escalation or a reduction in dose interval. In patients continuing treatment for over 1 year, the median FC was 184µg/g (range 30–9000) with a median reduction in FC level post-treatment of 416µg/g (range –3000–7086) and a median HBI of 4 (range 0–16). 57.1% could be defined as being in clinical remission with HBI < 5.
Conclusion In our large cohort of CD patients, few patients discontinued infliximab due to clinical remission. In those continuing infliximab for over 1 year the median FC was low, suggesting good control of inflammation, and the majority of patients were in clinical remission as defined by a HBI < 5. These results support the efficacy of infliximab as maintenance therapy in CD but suggest that despite evidence of clinical remission the majority of patients continue therapy.
Disclosure of Interest None Declared.
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