Sustained clinical benefit, improved quality of life, and reduced intestinal surgery from maintenance infliximab treatment in inflammatory bowel disease^*

Abstract

Objectives: Anti-TNF treatment is established for patients with severe inflammatory bowel disease (IBD) refractory to conventional medication. However, long-term real-life observations are limited. We have monitored 200 patients with primary response to infliximab (Remicade^®).

Methods: Patients with either Crohn’s disease (CD) or ulcerative colitis (UC) who started IFX and had clinical response at 1 year were prospectively followed. C-reactive protein (CRP), albumin, fecal calprotectin (FCP), Harvey Bradshaw index (HBI) in CD cases, and Quality of Life index were monitored. Concomitant medications, surgery and hospitalisation were assessed.

Results: Out of the 200 patients, 164 suffered from CD. Median disease duration was 5.0 (0.2–44.0) years and the observation time was 3.4 (1.0–13.9) years. Steroid use was reduced from 51% to 10%. HBI in CD patients decreased from 8.0 ± 0.40 to 2.7 ± 0.26. Disease activity in UC patients was only assessed by biochemical markers. CRP decreased from 29.0 ± 6.2 to 8.0 ± 7.1 mg/L. FCP showed a decrease from 1918 (1837) to 191 (646) mg/kg. Hospitalization showed similar tendency and quality of life was improved. Twenty-seven percent had been operated before IFX introduction compared to 11% during the observation period. Loss of response was seen in 42 patients, of which 20 patients needed intestinal surgery.

Conclusion: Two-thirds of the patients demonstrated stable clinical benefit from maintenance IFX. The results show steroid-sparing efficacy as well as improved quality of life and reduced need for surgery.

Keywords:

• Infliximab
• Crohn’s disease
• ulcerative colitis
• inflammatory bowel disease
• surgery
• hospitalization
• QoL

Disclosure statement

Eberhardson has received honoraria for lectures and consultancy from AbbVie, Merck (MSD), Takeda, Ferring, Orion Pharma, Otsuka, Tillotts, ITH, Novartis, Pfizer and Janssen, and received research funding from AbbVie and MSD. Olsson is currently an employee of MSD Sweden. Aleman has received research grants from AbbVie and Gilead and has received honorary for lectures or expert group meetings from AbbVie, BMS, Gilead, and MSD.

Additional information

Funding

Eberhardson was supported by the Bengt Ihre Research Fellowship and the Stockholm County Council ALF funding. The study was supported by MSD as an investigator-initiated study.