A team from Cleveland, Ohio, USA, identified predictors of response to infliximab in Crohn's disease.
A total of 100 patients with either inflammatory or fistulous Crohn's disease, and at least 3 months of follow-up after infliximab infusion, were evaluated.
Clinical response and duration of response were measured.
For inflammatory disease, 73% of nonsmokers, compared with 22% of smokers, responded to infliximab.
Among patients taking concurrent immunosuppressives, 74% responded to infliximab, compared with 39% not taking any immunosuppressives.
Prolonged response (duration > 2 months) was achieved in 59% of nonsmokers compared with 6% of smokers, and in 65% of patients on immunosuppressives compared with 18% not on immunosuppressives.
For fistulous disease, overall response rates were not found to be different between nonsmokers and smokers. However, nonsmokers had a longer duration of response.
| Nonsmoking and immunosuppressive use enhance infliximab response in inflammatory disease.
| Gastroenterology |
The researchers discovered that concurrent use of immunosuppressive medications had no effect on either rate or duration of response.
Multivariable logistic regression analysis confirmed the harmful effect of smoking and the beneficial effect of immunosuppressive use on response in patients with inflammatory disease.
The same analysis for fistulous disease did not show an association between smoking or concurrent immunosuppressive use and response to infliximab.
Mansour A. Parsi, of the Cleveland Clinic Foundation, said on behalf of fellow authors, "In patients with inflammatory disease, nonsmoking and concurrent immunosuppressive use are associated with higher rates of response and longer duration of response to infliximab."
Dr Parsi concluded, "In patients with fistulous Crohn's disease, nonsmoking is associated with longer duration of response to infliximab."