Published online Jul 21, 2014. doi: 10.3748/wjg.v20.i27.9170
Revised: January 24, 2014
Accepted: April 2, 2014
Published online: July 21, 2014
Processing time: 250 Days and 17.1 Hours
AIM: To compare the need for infliximab dose intensification in two cohorts of patients with Crohn’s disease (CD) or ulcerative colitis (UC).
METHODS: Single centre, uncontrolled, observational study. Consecutive patients with CD and UC who responded to infliximab induction doses were included. Data collected in a prospectively maintained database were retrospectively analysed. Differences in the rates of dose intensification per patient-month and the intensification-free survival time were compared. We also evaluated the interval between the first infliximab induction dose and the first infliximab escalated dose. The weight-adjusted infliximab administration costs were also calculated.
RESULTS: Fifty nine patients with CD and 38 patients with UC were enrolled. The rate of intensification per patient-month was 3.9% for UC and 1.4% for CD (P = 0.005). The median time from baseline to intensification was significantly shorter in UC compared to CD [6.6 mo (IQR: 4.2-9.5 mo) vs 10.7 mo (IQR: 8.9-11.7 mo), P = 0.005]. In the survival analysis, the cumulative probability of avoiding infliximab dose intensification was significantly higher in CD (P = 0.002). In the multivariate analysis, disease (UC vs CD) was the only factor significantly associated with dose intensification. The infiximab administration costs during the first year were significantly higher for UC compared to CD (mean ± SD 234.9 ± 53.3 Euros/kg vs 212.3 ± 15.1 Euros/kg, P = 0.03).
CONCLUSION: The rate of infliximab dose intensification per patient-month is significantly higher in UC patients. The infliximab administration costs are also significantly higher in patients with UC.
Core tip: Infliximab dose intensification to counteract loss of response is well established in the management of patients with Crohn’s disease (CD). In ulcerative colitis, the need for infliximab dose intensification is less well established. The study compares for the first time the need for infliximab dose intensification for ulcerative colitis and CD in the same clinical setting. The need for infliximab dose intensification was significantly higher in patients with ulcerative colitis compared to patients with Crohn’s disease. The drug administration costs were also higher in patients with ulcerative colitis. Our data provide a rational basis for economic planning in patients with ulcerative colitis selected for anti-tumor necrosis factor-α therapy.