Infliximab Still Effective in IBD Patients After Break in Therapy

Infliximab shows efficacy in IBD patients who suspend therapy.

Infliximab shows efficacy in IBD patients who suspend therapy.

Infliximab can still be an effective therapy in patients who discontinued the medication, regardless of the reason for ceasing therapy, the results of a new study suggest.

Participants who achieved remission at the time their therapy was discontinued achieved a 78% response rate 1 year after resuming therapy. The strategy was 45% effective in participants who experienced an infusion site reaction or a loss of response, which may present an option in patients who failed other therapies.

“Clinicians understandably have been reluctant to rechallenge patients with infliximab given the fear of immediate or delayed hypersensitivity reactions with dose interruptions,” said Filip Baert, MD, lead study author. “This study provides the important message that restarting infliximab after a drug holiday is feasible.”

The study appeared in the September 2014 edition of Clinical Gastroenterology and Hepatology.

The cohort included 105 participants with Crohn’s disease and 23 participants with ulcerative colitis, who had an average of 15 months of therapy discontinuation. Reasons for therapy discontinuation included loss of response or infusion reactions in 28 participants, and remission or pregnancy in 100 participants, the authors noted.

Researchers observed only 7 severe infusion reactions, which tended to occur during the second or third infliximab induction. Simultaneous immunomodulator therapy prevented the reactions, the researchers found.

The results also suggest that pharmacologic monitoring should be started early after reintroducing infliximab therapy, in order to predict long-term efficacy and safety.

“Our findings suggest that starting infliximab after a history of prior therapy can be very beneficial to patients,” Dr. Baert said. “Most striking, response to infliximab can be regained in a subset of patients who previously had lost response to the treatment and failed several other treatments thereafter.”