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P160. Ten years of infliximab for Crohn's disease: Outcome in 469 patients from two tertiary referral centers

E.J. Eshuis1, C.P. Peters1, A.A. van Bodegraven2, J.F.W.M. Bartelsman1, W.A. Bemelman1, C.Y. Ponsioen1, P.C.F. Stokkers1

1Academic Medical Center, Amsterdam, The Netherlands; 2Free University Medical Center, Amsterdam, The Netherlands

Aim: Aim of this study was to assess the long-term efficacy of IFX therapy in Crohn's disease (CD) patients treated in a two referral center cohort.

Methods: All CD patients treated with IFX were assessed. Medical charts were retrospectively reviewed. Endpoints were efficacy, efficacy of retreatment, surgical abdominal intervention rates before and after IFX therapy and safety of therapy.

Results: A total of 488 patients received IFX. For 469 patients (96%) it was possible to assess effectiveness. Median length of follow-up was 4.45 year (IQR: 2.66–6.82). Seventy patients (15%) had an unsuccessful remission induction course. A total of 316 patients received maintenance therapy. Of those, a successful scheduled maintenance course was noted in 169/276 (61%). Episodic maintenance therapy was successful in 19/40 patients (48%).

One hundred thirty one patients received a second course of IFX therapy after discontinuation of the first course. A similar efficacy rate was noted (remission induction was successful in 82% and 65% had successful maintenance therapy). Twenty-seven out of 57 patients (47%) who received a second episode of treatment despite failure of the previous treatment, showed therapeutic success. In patients with treatment success, the rate of abdominal surgical interventions per 100 patient years was significantly reduced compared to before IFX therapy (a reduction of 4.25 interventions (95% CI −6.61 to −1.86; p < 0.001)). In the total cohort, the surgical intervention rate was not reduced. Mortality (1.9%; 0.39/100 patient years) and malignancy rates (3.4%; 0.70/100 patient years) were comparable to previous publications on safety.

Conclusion: The present study showed that on the long-term IFX was beneficial in 59% of CD patients in our cohort. Moreover, long-term use of IFX was safe and prevented surgery in patients with therapy success. Previous failre on IFX should not absolutely preclude its future use in individual patients.