Digestive Diseases and Sciences

, Volume 57, Issue 4, pp 1013–1019 | Cite as

Durability of Infliximab Dose Intensification in Crohn’s Disease

  • Kirk K. Lin
  • Fernando Velayos
  • Elena Fisher
  • Jonathan P. Terdiman
Original Article

Abstract

Background

Dose intensification is a common approach to treat Crohn’s disease (CD) patients who lose response to infliximab maintenance therapy. Few studies have reported upon its long-term efficacy or predictors of response.

Aim

The goal of this study is to investigate durability and predictors of response to dose intensification—including method of dose intensification, combination immunomodulator therapy, and premedication with intravenous hydrocortisone.

Methods

We performed a retrospective study of dose-intensified CD patients at our institution. Dose intensification was defined as an increase in dose from 5 to 10 mg/kg, an increase in frequency of infusions from every 8 weeks to every 6 weeks or less, or both an increase in dose and frequency.

Results

Thirty CD patients (mean age, 39.9 years) met study criteria and underwent dose intensification. Ten (33.3%) patients remained on dose intensification at the end of our study or returned to their former infliximab dose or schedule (median follow-up, 41 months). Fourteen patients (46.7%) eventually lost response to dose intensification, but dose intensification extended infliximab therapy by a median duration of 9 months. Six patients (20%) didn’t respond to dose intensification. Neither method of dose intensification, combination immunomodulator therapy, nor premedication with intravenous hydrocortisone predicted initial or durable response to dose intensification. However, analysis of predictors was limited by the small sample size of our study.

Conclusions

The majority of CD patients respond to dose intensification, and a substantial portion will experience durable response such that infliximab therapy is successfully extended by one or more years.

Keywords

Infliximab Dose intensification Response Durability 

Notes

Conflict of interest

The authors have no commercial, proprietary, or financial interest in the products described in this article.

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Kirk K. Lin
    • 1
    • 2
  • Fernando Velayos
    • 1
  • Elena Fisher
    • 1
  • Jonathan P. Terdiman
    • 1
  1. 1.Division of Gastroenterology, Department of Internal MedicineUniversity of California at San FranciscoSan FranciscoUSA
  2. 2.Center for Colitis and Crohn’s DiseaseUniversity of California at San FranciscoSan FranciscoUSA

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