Purpose: Infliximab (IFX) is a very effective therapy for inflammatory bowel disease (IBD), but many patients lose response during the first few years of therapy. There is little data regarding the loss of response (LOR) after five years of treatment (Rx). The aim is to evaluate LOR and side effects (SE) to IFX after five years of Rx in our pediatric and young adult IBD population. Methods: We conducted a retrospective chart review of all the patients who received IFX in our practice. We collected clinical data and especially the reasons for modifying or stopping Rx. Results: Over a 12-year period, we treated 252 IBD patients with IFX (232 had Crohn's disease, 18 had ulcerative colitis and two had undifferentiated colitis). There were 156 males and 96 females, with an age range at the onset of Rx of ten months to 21 years, with a mean of 11.5 years. 124 were treated for less than two years, 63 between two and five years, and 47 over five years (including three for over ten years). We had incomplete information on 18. Of the 63 who received the IFX for 2 to 5 years, 34 (54%) are still on Rx and 29 (46%) are off Rx. The dose or the Rx frequency increased in 14 of the 34 still receiving IFX (41%) and 13 of the 29 that stopped (45%). The reason for stopping the Rx was LOR in 18 (8 after the dosage was increased), an acute infusion reaction in 3, patients preference in 2, remission in 2, intra abdominal carcinoma in 1, high-grade cervical dysplasia in 1, surgery in 1 and was unknown in 1. Of the 47 who received IFX for more than 5 years, 36 (76.5%) are still on Rx and 11 (23.5%) are off Rx. The dose or the Rx frequency was increased in 20 of the 36 still receiving Rx (55.5%) and 5 of the 11 that stopped Rx (45.4%). The reasons for stopping Rx was LOR in 6 (3 after the dose was increased), an acute infusion reaction in 1,delayed infusion reaction in1, peripheral neuropathy in 1 and patient preference in 2. There were 7 major complications: 3 malignancies, 2 cervical dysplasias, one peripheral neuropathy and one developed pancreatitis followed by chronic renal failure. Three died, one with intra abdominal carcinoma, one who had a liver transplant and then developed PTLD (while off IFX) and one from a surgical complication. Conclusion: Our data shows loss of response to Infliximab may occur after more than five years of continuous Infliximab treatment. In addition, a significant number of our patients required an increase in dose or frequency of treatment.Table: Table. Reasons of ending therapy
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