Digestive Diseases and Sciences

, Volume 53, Issue 4, pp 1033–1041

Long-Term Durability of Crohn’s Disease Treatment with Infliximab

  • Stephen J. Rudolph
  • David I. Weinberg
  • Robert P. McCabe
Original Paper


Background There is a paucity of data providing insight into the durability of Crohn’s disease treatment with infliximab for periods longer than 12 months. Our aim was to assess the long-term durability of infliximab therapy. Materials and Methods A total of 198 Crohn's patients under a maintenance regimen with infliximab, with at least a 30-month follow-up, were evaluated retrospectively. Long-term response maintenance was estimated using Kaplan-Meier analysis. The effect of specific variables was calculated using logistic regression and proportional hazard regression analyses. Results Maintenance of response rates at 72 months was estimated to be 66.4% for initial responders and 58.2% for all patients treated. Concurrent immunomodulators enhanced response maintenance in all patients treated, particularly if started >3 months before the initiation of infliximab therapy. Smoking significantly decreased the maintenance of response in initial responders. Conclusions Infliximab treatment of Crohn’s disease is reasonably durable beyond 12 months. Concurrent immunosuppressive therapy may increase – and smoking may decrease – long-term response maintenance.


Antibodies Azathioprine Crohn’s disease Infliximab 6-Mercaptopurine Smoking 


  1. 1.
    Arnott ID, McNeill G, Satsangi J (2003) An analysis of factors influencing short-term and sustained response to infliximab treatment for Crohn’s disease. Aliment Pharmacol Ther 17(12):1451–1457PubMedCrossRefGoogle Scholar
  2. 2.
    Cadahia V, Garcia-Carbonero A, Vivas S et al (2004) Infliximab improves quality of life in the short-term in patients with fistulizing Crohn’s disease in clinical practice. Rev Esp Enferm Dig 96(6):369–74; 374–378Google Scholar
  3. 3.
    Laharie D, Salzmann M, Boubekeur H et al (2005) Predictors of response to infliximab in luminal Crohn’s disease. Gastroenterol Clin Biol 29(2):145–149PubMedCrossRefGoogle Scholar
  4. 4.
    Luna-Chadid M, Perez Calle JL, Mendoza JL et al (2004) Predictors of response to infliximab in patients with fistulizing Crohn’s disease. Rev Esp Enferm Dig 96(6):379–81; 382–384Google Scholar
  5. 5.
    Parsi MA, Achkar JP, Richardson S et al (2002) Predictors of response to infliximab in patients with Crohn’s disease. Gastroenterology 123(3):707–713PubMedCrossRefGoogle Scholar
  6. 6.
    Present DH, Rutgeerts P, Targan S et al (1999) Infliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med 340(18):1398–1405PubMedCrossRefGoogle Scholar
  7. 7.
    Rodrigo L, Perez-Pariente JM, Fuentes D, et al (2004) Retreatment and maintenance therapy with infliximab in fistulizing Crohn’s disease. Rev Esp Enferm Dig 96(8):548–54; 554–558Google Scholar
  8. 8.
    Rutgeerts P, Feagan BG, Lichtenstein GR et al (2004) Comparison of scheduled and episodic treatment strategies of infliximab in Crohn’s disease. Gastroenterology 126(2):402–413PubMedCrossRefGoogle Scholar
  9. 9.
    Sands BE, Anderson FH, Bernstein CN et al (2004) Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med 350(9):876–885PubMedCrossRefGoogle Scholar
  10. 10.
    Targan SR, Hanauer SB, van Deventer SJ et al (1997) A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn’s disease. Crohn’s Disease cA2 Study Group. N Engl J Med 337(15):1029–1035PubMedCrossRefGoogle Scholar
  11. 11.
    van Dullemen HM, van Deventer SJ, Hommes DW et al (1995) Treatment of Crohn’s disease with anti-tumor necrosis factor chimeric monoclonal antibody (cA2). Gastroenterology 109(1):129–135PubMedCrossRefGoogle Scholar
  12. 12.
    Wenzl HH, Reinisch W, Jahnel J et al (2004) Austrian infliximab experience in Crohn’s disease: a nationwide cooperative study with long-term follow-up. Eur J Gastroenterol Hepatol 16(8):767–773PubMedCrossRefGoogle Scholar
  13. 13.
    Mortimore M, Gibson PR, Selby WS, Radford-Smith GL, Florin TH (2001) Early Australian experience with infliximab, a chimeric antibody against tumour necrosis factor-alpha, in the treatment of Crohn’s disease: is its efficacy augmented by steroid-sparing immunosuppressive therapy? The Infliximab User Group. Intern Med J 31(3):146–150PubMedCrossRefGoogle Scholar
  14. 14.
    Cohen RD, Tsang JF, Hanauer SB (2000) Infliximab in Crohn’s disease: first anniversary clinical experience. Am J Gastroenterol 95(12):3469–3477PubMedCrossRefGoogle Scholar
  15. 15.
    Farrell RJ, Shah SA, Lodhavia PJ et al (2000) Clinical experience with infliximab therapy in 100 patients with Crohn’s disease. Am J Gastroenterol 95(12):3490–3497PubMedCrossRefGoogle Scholar
  16. 16.
    Ricart E, Panaccione R, Loftus EV, Tremaine WJ, Sandborn WJ (2001) Infliximab for Crohn’s disease in clinical practice at the Mayo Clinic: the first 100 patients. Am J Gastroenterol 96(3):722–729PubMedCrossRefGoogle Scholar
  17. 17.
    Hanauer SB, Feagan BG, Lichtenstein GR et al (2002) Maintenance infliximab for Crohn’s disease: the ACCENT I randomised trial. Lancet 359(9317):1541–1549PubMedCrossRefGoogle Scholar
  18. 18.
    Rutgeerts P, D’Haens G, Targan S et al (1999) Efficacy and safety of retreatment with anti-tumor necrosis factor antibody (infliximab) to maintain remission in Crohn’s disease. Gastroenterology 117(4):761–769PubMedCrossRefGoogle Scholar
  19. 19.
    Hanauer SB, Wagner CL, Bala M et al (2004) Incidence and importance of antibody responses to infliximab after maintenance or episodic treatment in Crohn’s disease. Clin Gastroenterol Hepatol 2(7):542–553PubMedCrossRefGoogle Scholar
  20. 20.
    Lichtenstein GR, Yan S, Bala M, Blank M, Sands BE (2005) Infliximab maintenance treatment reduces hospitalizations, surgeries, and procedures in fistulizing Crohn’s disease. Gastroenterology 128(4):862–869PubMedCrossRefGoogle Scholar
  21. 21.
    Feagan BG, Yan S, Bala M, Bao W, Lichtenstein GR (2003) The effects of infliximab maintenance therapy on health-related quality of life. Am J Gastroenterol 98(10):2232–2238PubMedCrossRefGoogle Scholar
  22. 22.
    Present DH, Korelitz BI, Wisch N, Glass JL, Sachar DB, Pasternack BS (1980) Treatment of Crohn’s disease with 6-mercaptopurine. A long-term, randomized, double-blind study. N Engl J Med 302(18):981–987PubMedCrossRefGoogle Scholar
  23. 23.
    Lichtenstein GR, Abreu MT, Cohen R, Tremaine W, American Gastroenterological A (2006) American Gastroenterological Association Institute technical review on corticosteroids, immunomodulators, and infliximab in inflammatory bowel disease. Gastroenterology 130(3):940–987PubMedCrossRefGoogle Scholar
  24. 24.
    Baert F, Noman M, Vermeire S et al (2003) Influence of immunogenicity on the long-term efficacy of infliximab in Crohn’s disease. N Engl J Med 348(7):601–608PubMedCrossRefGoogle Scholar
  25. 25.
    Maini RN, Breedveld FC, Kalden JR et al (1998) Therapeutic efficacy of multiple intravenous infusions of anti-tumor necrosis factor alpha monoclonal antibody combined with low-dose weekly methotrexate in rheumatoid arthritis. Arthritis Rheum 41(9):1552–1563PubMedCrossRefGoogle Scholar
  26. 26.
    Farrell RJ, Alsahli M, Jeen YT, Falchuk KR, Peppercorn MA, Michetti P (2003) Intravenous hydrocortisone premedication reduces antibodies to infliximab in Crohn’s disease: a randomized controlled trial. Gastroenterology 124(4):917–924PubMedCrossRefGoogle Scholar
  27. 27.
    Fefferman DS, Lodhavia PJ, Alsahli M et al (2004) Smoking and immunomodulators do not influence the response or duration of response to infliximab in Crohn’s disease. Inflamm Bowel Dis 10(4):346–351PubMedCrossRefGoogle Scholar
  28. 28.
    Kinney T, Rawlins M, Kozarek R, France R, Patterson D (2003) Immunomodulators and “on demand” therapy with infliximab in Crohn’s disease: clinical experience with 400 infusions. Am J Gastroenterol 98(3):608–612PubMedGoogle Scholar
  29. 29.
    Vermeire S, Louis E, Carbonez A et al (2002) Demographic and clinical parameters influencing the short-term outcome of anti-tumor necrosis factor (infliximab) treatment in Crohn’s disease. Am J Gastroenterol 97(9):2357–2363PubMedCrossRefGoogle Scholar
  30. 30.
    Keshavarzian A, Mayer L, Salzberg B et al (2007) A multicenter retrospective experience of infliximab in Crohn’s disease patients: Infusion reaction rates and treatment persistency. Gastroenterol Hepatol 3:381–390Google Scholar
  31. 31.
    Breuer-Katschinski BD, Hollander N, Goebell H (1996) Effect of cigarette smoking on the course of Crohn’s disease. Eur J Gastroenterol Hepatol 8(3):225–228PubMedCrossRefGoogle Scholar
  32. 32.
    Cosnes J, Carbonnel F, Beaugerie L, Le Quintrec Y, Gendre JP (1996) Effects of cigarette smoking on the long-term course of Crohn’s disease. Gastroenterology 110(2):424–431PubMedCrossRefGoogle Scholar
  33. 33.
    Thomas GA, Rhodes J, Green JT (1998) Inflammatory bowel disease and smoking—a review. Am J Gastroenterol 93(2):144–149PubMedGoogle Scholar
  34. 34.
    Su C, Lichtenstein GR (2005) Are there predictors of Remicade treatment success or failure? Adv Drug Deliv Rev 57(2):237–245PubMedCrossRefGoogle Scholar
  35. 35.
    Colombel JF, Loftus EV Jr, Tremaine WJ et al (2004) The safety profile of infliximab in patients with Crohn’s disease: the Mayo clinic experience in 500 patients. Gastroenterology 126(1):19–31PubMedCrossRefGoogle Scholar
  36. 36.
    Thayu M, Markowitz JE, Mamula P, Russo PA, Muinos WI, Baldassano RN (2005) Hepatosplenic T-cell lymphoma in an adolescent patient after immunomodulator and biologic therapy for Crohn disease. J Pediatr Gastroenterol Nutr 40(2):220–222PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Stephen J. Rudolph
    • 1
    • 2
  • David I. Weinberg
    • 1
    • 2
  • Robert P. McCabe
    • 1
    • 2
  1. 1.Minnesota Gastroenterology, P.A.PlymouthUSA
  2. 2.Department of Medicine, Division of GastroenterologyUniversity of Minnesota Medical SchoolMinneapolisUSA

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