Background Infliximab (INF) is a chimeric immunoglobulin antibody to tumour necrosis factor (A-TNF) approved for the treatment of Crohn’s disease and ulcerative colitis.
Guidelines recommend a 5 mg/kg dose given as induction regimen in weeks 0, 2 and 6, followed by a maintenance regimen of 5 mg/kg every 8 weeks. However, a significant rate of patients with an initial response, later experience the return of the active disease despite ongoing INF maintenance treatment. International guidelines suggest intensifying the INF regimen if the treatment fails, by increasing the dose to 10 mg/kg, or decreasing the interval to 5 mg/kg every 6 weeks.
Purpose To analyse the different intensification strategies used in a tertiary university hospital, and their results.
Material and methods Single-centre, retrospective, observational study. Information was obtained from both the Farmatools application and clinical histories. Fifty-five patients were included in our study; all of them started INF treatment between 2005 and 2013.
Results Out of 55 patients enrolled: 60% (33) were responders, 9% (5) were non-responders, 27% (15) loss of response, and (4%) 2 didn’t tolerate INF.
The treatment of the 22 patients who didn’t respond satisfactorily was modified: in 73% (16) the interval was shortened, 9% (2) stepped up to 10 mg and 5% (1) the interval were shortened and the dose stepped up to 10 mg. The other 14% (3) were moved to another A-TNF.
In our study, shortening the interval was effective in 52% of cases (9/16), stepping up to 10 mg in 100% (2/2), and the combination of the two strategies in 100% (1/1).
Conclusion INF induces remission in most of the patients following the usual maintenance regimen.
In our hospital the favourite intensification strategy is to shorten the interval. The use of another A-TNF is reserved for hypersensitivity reactions or for failure of the previous intensification.
Both intensification strategies were effective, though more information is required to choose the best strategy.
References and/or Acknowledgements No conflict of interest.
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