P352 Infliximab-therapy intensification based on endoscopic activity suppresses treatment interruption among patients with Crohn’s disease

Abstract

Abstract Background Although biologics have improved the therapeutic goals for Crohn’s disease, the problem of diminishing efficacy exists. With recent advances, it is possible to administer double doses or shortening the dosing interval of infliximab (IFX); however, its effectiveness and right timing of strengthening remain unclear. In this study, we examined the treatment outcomes in patients with Crohn’s disease who received IFX-therapy intensification for the reduction of IFX effects at multiple centres. Methods Of the 243 patients with Crohn’s disease who were seen at our hospital and related facilities from July 2002 to July 2018, a total of 46 patients who could be observed for more than 1 year after IFX-therapy intensification for diminished effect of IFX were included in this study. The relationship between patient background and continuation of therapy intensification was retrospectively examined using logistic regression analysis. Furthermore, the relationship between therapy intensification and the treatment discontinuation rates for each of double doses and shortening the dosing interval was also evaluated. Results Of the 46 patients (30 men and 16 women), 67.4% (31 cases) were able to continue therapy intensification for 12 months. In univariate analysis of the relationship between patient background and continuation of therapy intensification, therapy intensification due to the remaining endoscopic findings contributed to the decrease in therapy intensification interruption rate. However, multivariate analysis did not reveal any significant contributing factors. Next, treatment discontinuation rates were compared between the group in which therapy intensification was performed due to the remaining endoscopic findings (n = 14) or clinical symptoms (abdominal pain, diarrhoea, and subjective general condition) (n = 32). The rate of treatment discontinuation 12 months after treatment strengthening was significantly lower in the therapy intensification group due to the remaining endoscopic findings than in that due to clinical symptoms (7.1% vs. 43.8%, p = 0.015). The rates of treatment discontinuation between the group of double doses (n = 34) and the group of shortening the dosing interval (n = 12) were also compared, but there was no significant difference after 6 or 12 months of treatment strengthening. Conclusion Treatment interruption would less likely occur among patients with Crohn’s disease receiving IFX if IFX-treatment intensification is triggered by the remaining endoscopic findings and not by clinical symptoms.