Crohn's disease: loss of response to infliximab common, possibly preventable in meta-analysis

  • Zhang QW & al.
  • J Dig Dis
  • 23 Dec 2018

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Loss of response (LOR) to maintenance infliximab therapy affects 36% of patients receiving the drug for Crohn's disease (CD), and may be prevented by combining with immunosuppression (IMM) therapy, according to a meta-analysis.

Why this matters

  • Combination IMM therapy may be advised during infliximab maintenance.

Study design

  • Meta-analysis of 26 studies (n=3187) after search of PubMed, EMBASE, and the Cochrane Library.
  • 22 of the studies were observational; 4 were randomized controlled trials (RCTs).
  • LOR was defined as reemergence of disease activity after achieving induction response, combined with need for alternative therapy.
  • Funding: National Natural Science Foundation of China.

Key results

  • At a median follow-up of 1.05 years, 36% (95% CI, 29%-42%) of patients with CD developed infliximab LOR.
  • The incidence of LOR was increased by these factors:
    • perianal lesions (OR, 1.87; P=.02);
    • colon involvement (OR, 2.56; P=.02); and
    • younger age at CD onset (weighted mean difference, −0.79; P=.01).
  • The incidence of LOR was decreased by 58% in patients receiving IMM therapy (OR, 0.42; P=.001).

Limitations

  • No double-blind RCTs were included; most studies observational.
  • Small sample sizes per study.

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