P240. A study of infliximab therapy for Crohn's disease following NICE TAG 187 in two UK district general hospitals
M. Kumar1, K. Bundhoo1, P. Kitchen2, R. Ede1
1Dartford and Gravesham NHS Trust, Gastroenterology, Dartford, United Kingdom; 2Medway NHS Foundation Trust, Gastroenterology, Gillingham, United Kingdom
Background: Infliximab is a standard treatment for severe Crohn's disease in UK district general hospitals (DGHs). We present our experience of using Infliximab for Crohn's disease in two UK DGHs and compare our practice to standards published in UK NICE guidance 2010 TAG 1871.
Methods: A data collection proforma was designed based on NICE TAG 187. All patients on infliximab therapy for Crohn's disease were identified through pharmacy database. Data was assimilated on all Crohn's patients (n = 42) treated with and currently on infliximab therapy from medical notes and results analysed.
Results: 42 patients were studied, 23 were male. Mean age was 34 years (range 2165). Most common indication was fistulating Crohn's disease. All patients satisfied NICE criteria for severe Crohn's disease. 34 (81%) patients were on azathioprine for an average duration of 35 months and 29 (69%) patients were steroid dependant prior to infliximab. 37 (88%) patients achieved clinical remission after induction therapy and continued onto maintenance therapy of whom 28 (76%) remained in remission for mean duration of 26 months and mean number of infusions = 16. Pearson's Chi-square tests were used to analyse statistical significance of treatment outcomes. Longer duration of therapy (mean 26 months) resulted in significantly higher remission rates (χ2 (1) = 10.36, p < 0.001, 95% CI). 9 (24%) patients lost response to infliximab after a mean duration of 26 months and 4 (11%) needed surgery after a mean duration of 19 months. 4 (11%) patients developed minor septic complications whilst on therapy.
Conclusions: This study demonstrates that infliximab is very effective in inducing and maintaining remission in severe Crohn's disease . Although NICE guidelines recommend trial of withdrawal of infliximab after 12 months , we believe that longer durations of treatment in severe fistulating Crohn's disease results in significantly higher remission rates  with no significant adverse effects [2,3] and reduces the need for surgery. Early withdrawal may precipitate a relapse, especially in patients who have lost response to immunomodulators previously. Infliximab can be safely continued for longer durations.
1. National Institute of Clinical Excellence (2010), NICE TAG 187, London, http://www.nice.org.uk/nicemedia/live/12985/48553/48553.doc.
2. Hamzaoglu H, Cooper J, Alsahli M, Falchuk KR et al. (2010), Safety of infliximab in Crohn's disease: a large single-centre experience, Inflammatory Bowel Disease, 210916, 16(12).
3. Teshima CW, Thompson A, Dhanoa L et al. (2009), Long-term response rates to infliximab therapy for Crohn's disease in an outpatient cohort, Canadian Journal of Gastroenterology, 34852, 23(5).