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P397. Outcomes after dose escalation of infliximab in Japanese patients with Crohn's disease

M. Sako, T. Kawaguchi, A. Hirayama, G. Fukushi, K. Hayama, T. Fujiwara, N. Yoshimura, M. Takazoe, Social Insurance Central Hospital, Centre for Inflammatory Bowel Disease, Tokyo, Japan

Background

The scheduled maintenance therapy of infliximab (IFX) for Crohn's disease (CD) may require dose escalation due to secondary loss of efficacy. There are limited data on the response to an intensified infliximab regimen for Japanese patients with CD.

Methods

We performed a retrospective survey of 35 patients with CD who had received IFX 5 mg/kg every 5–7 weeks and has begun infusion of IFX 10 mg/kg. They received IFX therapy in extended intervals if duration period of the drug get longer. We analyzed the proportion of the patients who could extend the intervals of IFX therapy.

Results

Rapid clinical response was observed in 15/35 patients (42.9%) and they could extend intervals of infusion in one year. Among 29 patients followed over 24 months, 20.7% (6/29) were maintained in clinical remission with IFX given every 8 weeks at 12 months and 34.5% (10/29) at 24 months after the dose adjustment. 57.1% (20/35) of the patients had no change in duration of response to IFX. 7/20 patients stopped IFX therapy because of the need for surgical resection (5 patients, 4 of them continued IFX 5 mg/kg every 8 weeks after surgery), or symptoms of intestinal stenosis, no response (one patient, respectively). Two patients experienced gradual loss of efficacy. Azathioprine was used concomitantly in 5/20 patients who showed poor response to escalation, yet in resoponders, there was no concomitant treatment with immunomodulatory agents. Patients who could get longer intervals of IFX had started dose escalation earlier compared with those who had showed poor response (15.5±10.2 months vs. 41.5±18.7 months from the beginning of initial IFX therapy, p < 0.05). The CDAI of the patients achieving response were relatively lower (158±96.1) at the beginning of dose intensification than the poor responders (181±63.4). There was no disparity between them in C-reactive protein at dose escation (1.5 mg/L vs. 1.7 mg/L).

Conclusion

42.9% of the patients successfully extended duration of efficacy of IFX within 2 years after dose escalation. Early intensification of IFX might lead higher rate of early remission induction.