Durability of Infliximab in Crohn's Disease: A Single-Center Experience

Background: Infliximab is effective maintenance for moderate to severe Crohn's disease (CD); however, problems with immunogenicity and decreased efficacy often complicate long-term use. Durability of infliximab maintenance therapy over multiple years has not been defined. Methods: This was a retrospective, observational study of CD patients who received maintenance infliximab for >= 1 year with the intention of ongoing maintenance. Patients were categorized into those who either discontinued treatment or continued maintenance therapy. We examined the impact of demographic, clinical characteristics. and prior episodic exposure on long-term durability of infliximab therapy and also examined the reasons for discontinuation of therapy. Results: A total of 153 CD patients received maintenance infliximab treatment beyond I year and 42 (27%) ultimately discontinued treatment. The mean duration of maintenance treatment lit the time of discontinuation was 42.4 +/- 19.1 months compared to a follow-up period of 49.4 +/- 19.8 months in the cohort continuing therapy (P = 0.049). The main reasons for discontinuation were allergy/adverse reaction (44.2%) and decreased efficacy (38.2%). Use of concomitant immunosuppression was similar between the 2 groups (78.6% versus 83.8%, P = NS). However, the discontinued group had a higher rate of prior episodic dosing compared to CD patients who continued maintenance (28.8% versus 11.7%, P = 0.025), while there was no difference in the rate of intensified dosing (57.2% versus 50.5%, P = NS). Conclusions: One-quarter of CD patients on long-term infliximab maintenance discontinued treatment. A history of prior episodic dosing was significantly associated with infliximab discontinuation, despite concomitant immunosuppression. These data emphasize the need for optimization of infliximab for successful long-term management.