Although infliximab is an effective treatment for refractory or fistulizing Crohn's disease (CD), about 30% of patients do not respond.
Identifying predictive factors of response is, therefore, important for optimizing clinical management and for better understanding infliximab's mechanisms of action.
In this study, published in the September issue of the American Journal of Gastroenterology, the team assessed whether demographic or clinical parameters influenced short-term response to infliximab.
The team examined the first 240 CD patients in the Belgian Infliximab Expanded Access Program for response to infliximab treatment. They assessed these patients at either 4 (refractory luminal CD) or 10 weeks (fistulizing CD) after the first infusion.
In addition, detailed information on age, sex, type of disease (fistulizing or refractory), Crohn's Disease Activity Index score, C-reactive protein, smoking habits, disease duration, localization of disease, concomitant medication, and previous surgery was obtained from all patients.
Finally, logistic regression and decision tree analyses were performed.
|Predictors of infliximab response:|
- Isolated colitis
- Concomitant immunosuppressive therapy
|American Journal of Gastroenterology|
In this study, 74% of patients were responders to infliximab treatment and 27% were not.
Stepwise logistic regression identified age (odds ratio, 0.971), isolated ileitis (0.359), and previous surgery (0.429) as inversely correlated with a response to infliximab.
While, isolated colitis (odds ratio, 1.905) and concomitant immunosuppressive treatment (2.670) were positively correlated with response.
Surprisingly, smoking habits were not retained as predictors for response.
Dr Severine Vermeire's team stated in conclusion, "In this large cohort of infliximab-treated CD patients, young age, Crohn's colitis, and concomitant immunosuppressive treatment were identified as independent variables favoring short-term response to infliximab".