Early Infliximab Could Change the Course of Crohn’s Disease

NEW YORK (Reuters Health) – For patients with Crohn’s disease (CD), starting infliximab early after diagnosis boosts the chance of achieving endoscopic remission and reduces the development of stenosis over the next two years, report clinicians from Germany.

In 2008, results of the step-up/top-down trial demonstrated a benefit of starting infliximab early after first diagnosis of CD. However, data on long-term effects of this treatment strategy in daily clinical practice are scarce, Dr. Fabian Schnitzler with Ludwig-Maximilians-University in Munich and colleagues note in Crohn’s and Colitis.

To investigate further, they took a look back at the effects of early (< 24 months after diagnosis) versus late (> 24 months) initiation of infliximab in CD on endoscopic remission rates, surgery rates and course of CD over two years.

The cohort included 242 CD patients – 94 early starters and 148 late starters – who were followed for two years. Before starting infliximab, disease activity was comparable between the two groups.

After infliximab initiation, Crohn’s Disease Activity Index (CDAI) scores decreased significantly and similarly in both groups. At 24 months’ follow-up, the CDAI was again comparable between the groups.

Most patients in both groups were in clinical remission after infliximab induction (infusions at weeks 0, 2 and 6 of 5 mg/kg body weight) and rates of remission were comparable between both groups (90.3% for early starters and 87.8% for late starters). Most patients in both groups remained in clinical remission until the end of follow-up at 24 months (89.1% for early and 85.8% for late starters).

Sixty-one early starters and 86 late starters underwent endoscopy after starting the biologic agent.

The results showed that almost half of the early starters achieved endoscopic remission within 24 months compared to only a quarter of the late starters (45.9% vs. 25.6%, P=0.013), the researchers report.

In addition, significantly fewer early starters developed intestinal stenosis during follow up compared to late starters (9.8% vs. 29.1%, P=0.007).

Logistic regression analysis showed that early infliximab initiation was the only relevant factor achieving endoscopic remission, with an odds ratio of 2.39 (P=0.016).

The researchers say this single-center experience with 242 CD patients showed that early start of infliximab within 24 months after first diagnosis has a positive effect on the course of the disease.

Support for the study was provided by Hexal AG, a part of the Sandoz division of Novartis, which sells an infliximab biosimilar. The authors have declared no relevant conflicts of interest.

SOURCE: https://bit.ly/387aDe1 Crohn’s & Colitis, online August 17, 2021.

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