Doubling the infliximab dose versus halving the infusion intervals in Crohn's disease patients with loss of response

Lior Katz, Javier P. Gisbert, Beth Manoogian, Kirk Lin, Casper Steenholdt, Gerassimos J. Mantzaris, Ashish Atreja, Yulia Ron, Arun Swaminath, Somal Shah, Ailsa Hart, Peter Laszlo Lakatos, Pierre Ellul, Eran Israeli, Mads Naundrup Svendsen, C. Janneke Van Der Woude, Konstantinos H. Katsanos, Laura Yun, Epameinondas V. Tsianos, Torben NathanMaria Abreu, Iris Dotan, Bret Lashner, Jorn Brynskov', Jonathan P. Terdiman, Peter D.R. Higgins, Maria Chaparro, Shomron Ben-Horin*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

103 Scopus citations

Abstract

Background: Intensifying infliximab therapy is often practiced in Crohn's disease (CD) patients losing response to the drug but there are no data if halving the interval is superior to doubling the dose. We aimed to assess the efficacy of infliximab dose intensification by interval-halving compared with dose-doubling. Methods: A multicenter retrospective study of CD patients losing response to infliximab was undertaken. The clinical outcome of patients whose infusion intervals were halved (5 mg/kg/4 weeks) was compared with patients treated by dose-doubling (10 mg/kg/8 weeks). Results: In all, 168 patients were included from 18 centers in Europe, USA, and Israel. Of these, 112 were intensified by dose-doubling and 56 received interval-halving strategy. Early response to dose-escalation was experienced by 86/112 (77%) patients in the dose-doubling group compared with 37/56 patients (66%) in the interval-halving group (odds ratio [OR] 1.7, 95% confidence interval [CI] 0.8-3.4, P = 0.14). Sustained clinical response at 12 months postescalation was maintained in 50% of patients in the dose-doubling group compared with 39% in the interval-halving group (OR 1.5, 95% CI 0.8-2.9, P = 0.2). On multivariate analysis, predictors of long-term response to escalation were a nonsmoking status, CD diagnosis between 16-40 years of age, and normal C-reactive protein (CRP). Conclusions: Dose intensification leads to a sustained regained response in 47% of CD patients who lost response to standard infliximab dose, but halving the infusion intervals is probably not superior to dose-doubling. Given the costs and patient inconvenience incurred by an additional infusion visit, the dose-doubling strategy may be preferable to the interval-halving strategy. (Inflamm Bowel Dis 2012;)

Original languageEnglish (US)
Pages (from-to)2026-2033
Number of pages8
JournalInflammatory bowel diseases
Volume18
Issue number11
DOIs
StatePublished - Nov 2012

Keywords

  • Crohn's disease
  • inflammatory bowel disease
  • infliximab

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

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