The Reasons for Discontinuation of Infliximab Treatment in Patients with Crohn's Disease: A Review of Practice at NHS Teaching Hospital

Introduction. There is little information on the reasons for discontinuing infliximab treatment in patients with Crohn's disease. The aim of this study was to document these reasons to determine if any were preventable which would allow patients to continue the therapy. Aims & Methods. A review of the medical notes was conducted at the Norfolk and Norwich University Hospital on patients with Crohn's disease treated with infliximab between 2002–2008 to determine the reasons for stopping it. Results. A total of 65 patients were identified who had treatment with infliximab, of whom 23 (35.3%) had their therapy stopped. The reasons for discontinuation of infliximab in the 23 patients were: 47.8% side effects, 17.4% refractory disease, 13.0% achieved remission and did not receive long-term maintenance treatment, 4.34% pregnancy, 4.34% death, and unknown 13.0%. Conclusions. The main reasons for the discontinuation of infliximab were side effects rather than a lack of clinical response.

Download Full-text

P665 Which second-line biologic after anti-TNF failure during Crohn’s disease: Ustekinumab or vedolizumab, a multicentre retrospective study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.793 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S547-S547 ◽

Cited By ~ 1

Author(s):

C Rayer ◽

X Roblin ◽

D Laharie ◽

B Caron ◽

M Flamant ◽

...

Keyword(s):

Crohn’S Disease ◽

Side Effects ◽

Crohn's Disease ◽

Clinical Response ◽

Risk Model ◽

Second Line ◽

Faecal Calprotectin ◽

Drug Survival ◽

Cumulative Probabilities

Abstract Background Anti-TNF antibodies treatments are the only first-line reimbursed biologics for Crohn’s disease (CD) in several countries. Recently, Vedolizumab (VDZ) and Ustekinumab (UST) were added to the therapeutic armamentarium for CD refractory to a first anti-TNF antibody. However, studies comparing these two compounds remain unavailable. Our aim was to compare their efficacy in second-line treatment in CD after failure of one TNF antagonist. Methods All patients with CD refractory (primary or secondary non-responders) to first anti-TNF treatment and receiving UST or VDZ as a second biologic were included retrospectively in 10 French tertiary centres. The remission and clinical response were assessed at week 14. On the long-term, the cumulative probabilities of being in remission were estimated using the Kaplan–Meier method and the associated factors using a Cox proportional risk model. The drug survival to assess efficacy as well as side effects was assessed by actuarial analysis. Results 88 patients were included, 50 (57%) females (mean age: 41 ± 15 years), 61 (69%) being treated with UST and 27 (31%) with VDZ. The first anti-TNF was discontinued for primary or secondary non-response in 66 (75%) patients and for side effects in 22 (25%) patients, without any difference between the anti-TNF antibody previously used. Among the 55 patients with endoscopic data at baseline, 55 (98%) had ulceration, a CRP above 5mg/l for 33/71 (46%) patients and a faecal calprotectin > 250 µg/g for the 12 patients tested. At week 14, no difference was observed for clinical response and clinical remission according to the type of treatment: the rate of clinical response and remission were 74% (UST)/58% (VDZ) (p = 0.20) and 33% (UST)/26% (VDZ) (p = 0.56), respectively. The only factor associated with short-term remission was the lack of optimisation prior to anti-TNF discontinuation (p = 0.038) regardless of the type of second-line therapy (UST, p = 0.02; VDZ, p = 0.03). After a mean follow-up of 67 weeks, the cumulative probabilities of being in remission at 6 and 12 months were 16% and 34% for UST and 25% and 44% for VDZ, respectively (p = 0.24 for UST vs. VDZ). The drug survival was higher in the UST group as compared with the VDZ group (HR (UST vs. VDZ) = 2.36 [1.02–5.5], p = 0.04). Conclusion Our preliminary results suggest that VDZ and UST have similar efficacy in the short- and long-term response when used as a second-line biologic therapy in CD refractory to a first anti-TNF antibody. These results will be complemented for the congress by the inclusion of additional patients recruited into this registry.

Download Full-text

P406 Mucosal healing in children with Crohn's disease on long term maintenance treatment

Journal of Crohn s and Colitis ◽

10.1016/s1873-9946(14)60526-2 ◽

2014 ◽

Vol 8 ◽

pp. S235

Author(s):

R. Muhammed ◽

R. Bremner ◽

W. Theodoric ◽

S. Protheroe ◽

S. Murphy

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Maintenance Treatment ◽

Mucosal Healing ◽

Term Maintenance

Download Full-text

Case report of severe constrictive perimyocarditis and ischemic hepatitis in a Crohn’s disease patient upon infliximab-induced lupus-like syndrome

Therapeutic Advances in Gastroenterology ◽

10.1177/17562848211044033 ◽

2021 ◽

Vol 14 ◽

pp. 175628482110440

Author(s):

Simon Hirschmann ◽

Sarah Fischer ◽

Entcho Klenske ◽

Katharina Dechant ◽

Jörg H.W. Distler ◽

...

Keyword(s):

Crohn’S Disease ◽

Case Report ◽

Side Effects ◽

Crohn's Disease ◽

Disease Patient ◽

Clinical Signs ◽

University Hospital ◽

Infliximab Treatment ◽

Ischemic Hepatitis ◽

Elevated Liver Enzymes

Anti-tumor necrosis factor (TNF) antibodies have become an indispensable part in the therapeutic landscape of treating inflammatory bowel disease (IBD) patients. Nevertheless, they can be associated with the occurrence of severe systemic side effects. Here, we report the case of a 23-year-old patient with ileocolonic Crohn’s disease in endoscopic remission under ongoing anti-TNF infliximab therapy with occurrence of novel generalized arthralgia, pleuritic chest pain, and dyspnea. Clinical, laboratory, and imaging diagnostic workup in an extended clinical routine setting at the University Hospital of Erlangen, Germany, was used by a multidisciplinary team consisting of gastroenterologists, radiologists, cardiologists, and rheumatologists to investigate the underlying cause of the clinical symptoms in the patient. The results received using the aforementioned diagnostic setup led to the diagnosis of severe constrictive perimyocarditis due to infliximab-induced lupus-like syndrome with distinct ANA reactivity and elevated anti-dsDNA levels. Furthermore, pronounced ischemic hepatitis was diagnosed. Infliximab treatment was immediately stopped, and initiated corticosteroid pulse therapy only led to partial response as it had to be reduced due to pronounced psychiatric side effects. Persistent signs of pericarditis required additional ibuprofen therapy, which led to subsequent resolution of cardial symptoms. Formerly elevated liver enzymes returned to normal, and there were no clinical signs of recurrence of Crohn’s disease activity over 18 months of follow-up. The patient was subsequently switched to ustekinumab therapy for further treatment of underlying Crohn’s disease. This case report describes for the first time severe infliximab-induced lupus-like syndrome in an IBD patient, concurrently mimicking ST-elevation myocardial infarction with MRI visualization of pericarditis, occurrence of ischemic hepatitis, and pronounced signs of systemic inflammation.

Download Full-text

P102 COMPLEX PERIANAL CROHN'S DISEASE: INFLUENCE OF THE LONG-TERM MAINTENANCE TREATMENT WITH INFLIXIMAB ON THE FISTULAE TRACKS ASSESSED THROUGH MAGNETIC RESONANCE

Journal of Crohn s and Colitis Supplements ◽

10.1016/s1873-9954(08)70113-7 ◽

2008 ◽

Vol 2 (1) ◽

pp. 36

Author(s):

M.I. Calvo ◽

M.I. Vera ◽

J. De la Revilla ◽

F. García ◽

M. Pastrana ◽

...

Keyword(s):

Crohn’S Disease ◽

Magnetic Resonance ◽

Crohn's Disease ◽

Maintenance Treatment ◽

Perianal Crohn’S Disease ◽

Term Maintenance ◽

Perianal Crohn's Disease

Download Full-text

Withdrawal of Long-Term Maintenance Treatment with Azathioprine Tends to Increase Relapse Risk in Patients with Crohn’s Disease

Digestive Diseases and Sciences ◽

10.1007/s10620-014-3419-5 ◽

2014 ◽

Vol 60 (5) ◽

pp. 1414-1423 ◽

Cited By ~ 23

Author(s):

Heimo H. Wenzl ◽

Christian Primas ◽

Gottfried Novacek ◽

Alexander Teml ◽

Anna Öfferlbauer-Ernst ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Maintenance Treatment ◽

Relapse Risk ◽

Term Maintenance

Download Full-text

W1268 The Course of Infliximab Discontinuation After Long-Term Maintenance Treatment in Crohn's Disease

Gastroenterology ◽

10.1016/s0016-5085(10)63159-9 ◽

2010 ◽

Vol 138 (5) ◽

pp. S-687

Author(s):

Alessandro Armuzzi ◽

Marina Rizzi ◽

Rita Monterubbianesi ◽

Manuela Marzo ◽

Michele Cicala ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Maintenance Treatment ◽

Term Maintenance

Download Full-text

Long-Term Outcomes of Infliximab Treatment in 582 Korean Patients with Crohn’s Disease: A Hospital-Based Cohort Study

Digestive Diseases and Sciences ◽

10.1007/s10620-016-4105-6 ◽

2016 ◽

Vol 61 (7) ◽

pp. 2060-2067 ◽

Cited By ~ 10

Author(s):

Sang Hyoung Park ◽

Sung Wook Hwang ◽

Min Seob Kwak ◽

Wan Soo Kim ◽

Jeong-Mi Lee ◽

...

Keyword(s):

Cohort Study ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Infliximab Treatment ◽

Long Term Outcomes ◽

Korean Patients

Download Full-text

Management of Crohn’s disease in an immunosuppressed COVID-19-positive patient: safety-driven prioritisation of nutritional therapy as a bridge to restarting immunosuppression

BMJ Case Reports ◽

10.1136/bcr-2020-239404 ◽

2021 ◽

Vol 14 (3) ◽

pp. e239404

Author(s):

Clare Harris ◽

Richard James Harris ◽

Louise Downey ◽

Markus Gwiggner

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

Patient Safety ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Nutritional Therapy ◽

Interleukin 12 ◽

Inflammatory Bowel ◽

Term Maintenance

Active inflammatory bowel disease (IBD), combined immunosuppression and corticosteroid therapy have all been identified as risk factors for a poor outcome in COVID-19 infection. The management of patients with both COVID-19 infection and active IBD is therefore complex. We present the case of a 31-year-old patient with Crohn’s disease, on dual immunosuppression with infliximab and mercaptopurine presenting with inflammatory small bowel obstruction and COVID-19 infection. The case highlights the use of nutritional therapy, which remains underused in the management of adults with IBD, to manage his flare acutely. Following negative SARS-CoV-2 PCR testing and SARS-CoV-2 IgG testing confirming an antibody response, ustekinumab (anti-interleukin 12/23) was prescribed for long-term maintenance.

Download Full-text