Low-dose maintenance therapy with infliximab prevents postsurgical recurrence of Crohn's disease

Sorrentino, Dario, Paviotti, Alberto, Terrosu, Giovanni, Avellini, Claudio, Geraci, Marco and Zarifi, Dimitra (2010) Low-dose maintenance therapy with infliximab prevents postsurgical recurrence of Crohn's disease. Clinical Gastroenterology and Hepatology, 8 7: 591-599. doi:10.1016/j.cgh.2010.01.016

Author Sorrentino, Dario
Paviotti, Alberto
Terrosu, Giovanni
Avellini, Claudio
Geraci, Marco
Zarifi, Dimitra
Title Low-dose maintenance therapy with infliximab prevents postsurgical recurrence of Crohn's disease
Journal name Clinical Gastroenterology and Hepatology   Check publisher's open access policy
ISSN 1542-3565
Publication date 2010-07
Sub-type Article (original research)
DOI 10.1016/j.cgh.2010.01.016
Volume 8
Issue 7
Start page 591
End page 599
Total pages 9
Place of publication Maryland Heights, MO, United States
Publisher W.B. Saunders Co.
Language eng
Formatted abstract
Background & Aims: Infliximab might prevent postsurgical recurrence of Crohn's disease. However, it is unclear whether long-term therapy is necessary and whether alternative strategies could be applied to minimize potential side effects and reduce the costs of treatment.

We performed a prospective cohort study in 12 consecutive patients, treated immediately after surgery with maintenance infliximab (5 mg/kg), who did not have clinical or endoscopic evidence of disease recurrence after 24 months; they were followed up for an additional year. Infliximab treatment was then discontinued; patients with disease recurrence, based on endoscopy (Rutgeerts score, ≥2), were given lower doses of infliximab (starting with 1 mg/kg) to re-establish mucosal integrity. Surrogate markers of disease activity (fecal calprotectin [FC], C-reactive protein, and erythrocyte sedimentation rate) were assessed after each infliximab dose.

Results: None of the patients had clinical or endoscopic recurrence of Crohn's disease 3 years after surgery. However, discontinuation of infliximab caused endoscopic recurrence after 4 months in 10 of 12 patients (83%). All 10 patients then were treated again with infliximab, which, at a dose of 3 mg/kg every 8 weeks, restored and maintained mucosal integrity for 1 year. Among the surrogate markers, FC levels correlated with endoscopic scores (Wald test, P < .0001).

Long-term maintenance therapy with infliximab is required to maintain mucosal integrity in patients after surgery for Crohn's disease. However, a dose of 3 mg/kg (a 40% reduction from the standard dose) was sufficient to avoid disease recurrence, determined by endoscopy, in all patients at 1 year. FC levels correlate with mucosal status at different infliximab doses.
Keyword Crohn's disease
Postoperative recurrence
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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