Infliximab in Crohn's disease – a pragmatic approach?

Aims: To assess the need for scheduled (maintenance) versus episodic (on demand) therapy for Crohn's patients responding to Infliximab.

Methods: 88 consecutive CD patients form the basis of this report. Fistulating disease was treated with infusions (5mgs/Kg) at 0, 2 & 6 weeks while those with luminal disease were given a single infusion and treated thereafter in an episodic manner if they had responded. Scheduled treatment was given only to those patients failing episodic treatment.

Results: 66 patients responded to treatment, of whom, 9 to date have required scheduled therapy. All but 5 patients were receiving concomitant immunomodulatory drugs and all received pre-treatment steroids if there was >3 months between infusions. Smoking status did not affect remission rates but non-smokers experienced less relapses. Five patients treated with episodic infusions have required surgery while 29 remain in remission for more than 12 months. Complications included death from ARDS in an 82-year old woman who responded to a single infusion and 3 allergic reactions in the “episodic“ group.

Conclusions: The majority of Crohn's patients treated with Infliximab can be managed with on demand therapy. The almost universal use of immunomodulatory drugs probably accounts for prolonged remission times.