1Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital IBD Group, Toronto, Canada. Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada.
2Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital IBD Group, Toronto, Canada. Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada. email@example.com.
Studies have demonstrated the benefit of dose optimization in the setting of secondary loss of response to infliximab in inflammatory bowel disease.
The aim of our study was to retrospectively investigate the rates of dose optimization in an inflammatory bowel disease cohort receiving maintenance infliximab therapy to determine if there are different rates of dose optimization between CD and UC cases and what impact this has on the durability of treatment effect.
Cases receiving infliximab for treatment of IBD between January 2008 and February 2014 were identified from an infusion center database. Cases receiving ≥ 4 infusions were included in the study. Details of infusion dosing and timing were obtained. A dose increase from 5 mg/kg to 10 mg/kg or a reduction in the dosing interval were considered a dose optimization.
412 cases were included in the study. 52.7% required at least one dose optimization. Dose optimization was more common in UC than in CD cases (67.2% vs 46.3%, p=0.00006). The median time to dose optimization was 7 months (95% CI 4.8-9.2) for UC cases and 27 months (95% CI 7.3-46.7) for CD cases, p=0.00003.
Here we have shown that dose optimization is required more frequently in UC than in CD with a significantly shorter time to dose optimization for UC cases than CD cases. While the majority of cases responding to induction therapy with infliximab will have a sustained response to therapy, over 50% will require a dose optimization during their treatment.