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P316 Prognosis of patients with inflammatory bowel disease in clinical remission after de-escalation of infliximab maintenance therapy from 8 to 12 weeks

J. M. Vázquez-Morón, B. Benítez-Rodríguez*, H. Pallarés-Manrique, M. Ramos-Lora

Hospital General Juan Ramón Jiménez, Gastroenterology Unit, Huelva, Spain

Background

Infliximab is an anti-tumour necrosis (TNF) drug that has shown high effectiveness for inducing and maintaining clinical remission in patients with inflammatory bowel disease. The pattern-established maintenance dose is administered every 8 weeks, but it has been shown that the effect of the dose can last between 8 and 12 weeks, being detectable infliximab serum 12 weeks following administration. We therefore consider that there is probably a group of patients that can be maintained in clinical remission with infliximab maintenance dose every 12 weeks, which would thereby reduce treatment costs.

Methods

Observational, analytical, and retrospective study of 25 patients with inflammatory bowel disease in clinical remission for at least 12 months to infliximab maintenance dose every 8 weeks, which includes de-escalation of infliximab every 12 weeks. Our aim was to analyse the number of patients maintaining clinical remission with de-escalation dose 12 weeks, and assess factors predicting relapse.

Results

The average age of patients was 46 years (± 14.8): 60% women, and 16 patients diagnosed with Crohn’s disease and 9 with ulcerative colitis. Average age at diagnosis was 32.5 years (± 15.8), and mean years of disease progression of 13.6 years (± 5.6). Further, 18 (72%) remained in clinical remission, with a median duration of de-escalation of infliximab maintenance dose every 12 weeks to 54 months. In addition, in 2 patients, infliximab discontinuation was definitive, and in 16, infliximab maintenance was continued every 12 weeks. Moreover, 7 patients (28%) had clinical recurrence during de-escalation of infliximab to 12 weeks (median maintenance of 9 months). Only 1 patient presented infusional reaction. On multivariate analysis, the only factor for clinical relapse was not performing combined immunosuppressive therapy because of intolerance, withdrawing, or abandoning (p = 0.032).

Conclusion

Maintenance therapy with infliximab every 12 weeks can be an effective regimen to maintain clinical remission in patients with infliximab for at least 12 months. Relapse is usually present in the first de-escalation infusions. Maintaining combination therapy with immunosuppressant can be an important factor in preventing clinical relapse during maintenance infliximab every 12 weeks.