Brief Article
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World J Gastroenterol. Jan 7, 2014; 20(1): 214-218
Published online Jan 7, 2014. doi: 10.3748/wjg.v20.i1.214
Time of infliximab therapy initiation and dose escalation in Crohn’s disease
Mindy CW Lam, Terry Lee, Kenneth Atkinson, Brian Bressler
Mindy CW Lam, Kenneth Atkinson, Brian Bressler, Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC V6Z 2K5, Canada
Terry Lee, Centre for Health Evaluation and Outcome Sciences, Vancouver, BC V6Z 2K5, Canada
Author contributions: Lam MCW is the primary author of the study and was involved in data collection; Lee T performed statistical analysis on the data and was involved in editing the manuscript; Atkinson K was content expert and involved in editing the manuscript; Bressler B was the principle investigator, content expert and involved in editing the manuscript.
Correspondence to: Brian Bressler, MD, Division of Gastroenterology, Department of Medicine, University of British Columbia,770-1190 Hornby Street, Vancouver, BC V6Z 2K5, Canada. brian_bressler@hotmail.com
Telephone: +1-604-6886332 Fax: +1-604-6892004
Received: June 6, 2013
Revised: September 20, 2013
Accepted: October 19, 2013
Published online: January 7, 2014
Processing time: 228 Days and 15.3 Hours
Abstract

AIM: To determine if early initiation of anti-tumor necrosis factor therapy affects the need for dose escalation.

METHODS: This was a retrospective review of patients receiving infliximab therapy for Crohn’s disease (CD) at two outpatient gastroenterology clinics during July 2009 to October 2010. All patients included in the study were biologic agent naïve and had moderate to severe CD (Harvey Bradshaw index > 8). Patients were divided into groups based on length of time between diagnosis to therapy initiation and concurrent immunosuppressant therapy. Kaplan-Meier survival analysis was used to compare the time to dose escalation for the four groups.

RESULTS: There were 68 patients, 51% female and 49% male, with an average age at diagnosis of 24.7 ± 11.9 years. The average age at infliximab initiation was 34.8 ± 14.8 years. Of the 68 patients, 19% initiated inflixiamb within 2 years of diagnosis, and 51% had concurrent immunosuppressant therapy at the time of therapy initiation. Fifty percent of patients required dose escalation and the median time from therapy initiation to dose escalation was 10 mo (interquartile range: 5.3-14.8). There was a statistically significant higher probability of requiring dose esclataion in patients who initiated biologic therapy within 2 years of diagnosis, without concurrent immunosuppressant therapy (P < 0.01).

CONCLUSION: Those who receive infliximab within 2 years of CD diagnosis require more intense immunosuppressant therapy than those who received infliximab later.

Keywords: Crohn’s disease; Infliximab; Dose escalation

Core tip: Crohn’s disease patients who required infliximab therapy earlier (< 2 years) probably have a higher inflammatory burden of disease than those who require infliximab therapy later. Our results show that those who receive infliximab within 2 years of diagnosis require more intense immunosuppressant therapy to avoid dose escalation. This finding supports the importance of concurrent immunosuppressant therapy while on infliximab, as previously described by the SONIC trial.