HomePublicationsCongress AbstractsAbstracts 2012Poster presentations: Clinical: Therapy and observation (2012)P309. Paradoxical inflammation, inflammatory bowel disease and infliximab

* = Presenting author

Poster presentations: Clinical: Therapy and observation (2012)

P309. Paradoxical inflammation, inflammatory bowel disease and infliximab


P. Sousa1, S. Silva2, M. Cravo1, P. Moura Santos1, L. Tavares1, A.R. Gonçalves1, A. Valente1, L. Correia1, F. Serejo1, J. Velosa1

1Hospital de Santa Maria, Gastrenterology, Lisboa, Portugal; 2Hospital Central do Funchal, Internal Medicine, Funchal, Portugal



Background: Phenomena of paradoxical inflammation (PPI) have been described in patients treated with Infliximab (IFX) but this information is scarce in inflammatory bowel disease (IBD) patients. The aim of this study was to evaluate the incidence of PPI in patients with IBD treated with IFX, the temporal association with dosage or administration interval and to characterize these phenomena, their evolution and management.

Methods: We reviewed the charts from all patients treated with IFX at our clinic. Acute infusional reactions were excluded. 64 patients were included [55 with Crohn's disease (CD) and 9 with ulcerative colitis (UC)], 38 males and 26 females; mean age 39 years (19–69). All patients were personally interviewed by the same investigator (PS) inquiring about possible PPI. Statistical analysis was performed using the program SPSS v. IBM 19.

Results: Mean duration of the treatment was 4 years (1–11).78% were on 5 mg/kg and 22% on 10 mg/kg. 30% of patients were receiving IFX every 6 weeks and 70% every 8/8 weeks. 20% of patients were on combination therapy with azathioprine (AZT) and 26.5% with amino­salicylate. We observed PPI in 33% of patients (19/55 with CD and 2/9 UC). No association was observed with dosage, interval of administrations, concomitant immunossupression or duration of treatment (> or <5 years). Time between 1st infusion and PIP varied from 4 mo to 6 yrs. Seven patients had foliculitis, 4 eczema, 5 arthritis/arthralgia, 5 psoriasis, 2 lupus, and 1 auto-immune hepatitis. In 6 patients (9.3%) IFX was stopped due to the severity of PPI (1 hepatitis, 2 lupus and 3 patients with psoriasis) and specific therapy to this complication was started. Suspension of IFX and therapy directed to the paradoxical reaction resulted in complete resolution in all patients. Two patients were later on re-started on IFX at lower dosage (3 mg/Kg), 2 were changed to adalimumab and 2 were treated with AZT.

Conclusions: PPI are common in patients treated with IFX (21/64) but severe reactions requiring suspension of IFX and specific treatment are rare (6/64). No association with duration of treatment, concomitant immunossupression, dosage or interval of administration was observed. Even in severe cases it is possible to re-introduce biologic therapy, at lower doses or with a different agent.