Maintenance infliximab does not result in increased abscess development in fistulizing Crohn's disease: results from the ACCENT II study

Background Rapid fistula healing may predispose Crohn's disease patients to abscess development. Aim Data from ACCENT II were analysed to determine whether fistula-related abscess development is affected by infliximab exposure. Methods Following infliximab 5 mg/kg infusions at weeks 0, 2 and 6, patients were evaluated for fistula response for two consecutive visits at least 4 weeks apart. Patients (N = 282) were randomized at week 14 to either placebo or infliximab 5 mg/kg every 8 weeks through week 46. If response was lost at or after week 22, patients could crossover to a 5 mg/kg higher infliximab dose. Fistula-related abscesses were diagnosed by physical examination or by imaging procedures according to usual practice. Results Infliximab exposure was approximately twofold higher for the infliximab maintenance group. Twenty-one (15%) patients in the infliximab maintenance group had at least one newly developed fistula-related abscess compared with 27 (19%) in the placebo maintenance group (P = 0.526). The proportion of patients with a new fistula-related abscess was similar regardless of whether or not patients crossed over to a 5 mg/kg higher infliximab dose. The number of fistula-related abscesses diagnosed over time did not differ between groups. Conclusion Abscess development in patients with fistulizing Crohn's disease is not dependent on cumulative infliximab exposure.