Summary
Background
The long-term efficacy of infliximab in patients with Crohn's disease is suboptimal.
Aim
To study prognostic factors for real-life long-term effcacy of infliximab in Crohn's disease.
Methods
All consecutive Crohn's disease patients treated with infliximab at a tertiary centre were retrospectively analysed. Only patients who received scheduled infliximab maintenance treatment were considered. Patient- and disease-related factors were used to identify independent predictors of infliximab failure-free survival using Cox proportional hazards regression.
Results
Of 1031 patients with Crohn's disease, 261 were eligible for inclusion. Median time on infliximab was 2.4 [IQR 1.4–4.7] years, and 65 (24.9%) patients experienced infliximab failure. Estimated 5-year infliximab failure-free survival was 65.9% (95% CI 58.3–73.5). Multivariate Cox regression identified disease duration ≥1 year (HR 2.5 (95% CI 1.2–5.2), P = 0.02), L1 disease location [HR 2.0 (1.1–3.5), P = 0.02], prior anti-TNF use [HR 2.3 (1.1–4.8), P = 0.03], haemoglobin <13.5 g/dL [HR 2.3 (1.2–4.4), P = 0.02], not using therapeutic drug monitoring [HR 8.0 (4.1–15.6), P = 1 × 10−9], and first dose optimisation within first year [HR 3.7 (2.1–6.6), P = 5 × 10−6] as independent predictors of infliximab failure-free survival. Stratifying patients into risk groups resulted in estimated 3-year infliximab failure-free survival rates ranging from 95.3% (94.2–96.4) to 26.3% (8.6–44.0) depending on the number of risk factors (P = 8 × 10−13).
Conclusions
This study identified several easy to obtain predictors of infliximab failure in patients with Crohn's disease, and these are in line with previous reports. Those with a high-risk profile for infliximab failure in whom infliximab initiation is considered, should be treated as early as possible making use of therapeutic drug monitoring.
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