Retreatment and maintenance therapy with infliximab in fistulizing Crohn' disease

Objectives: infliximab has clearly demonstrated its efficacy in the short-term treatment of fistulizing Crohn' disease. We present here the results of retreatment and long-term maintenance therapy. Patients and methods: eighty one consecutive patients with active fistulizing Crohn' disease, in whom previous treatments had failed, were treated with infliximab. All patients received as the initial treatment of 5 mg/kg i.v. infusions (weeks 0, 2, and 6). Those patients who failed to respond after the initial cycle (group 1, n= 25), or those who relapsed after having responded (group 2, n=13), received retreatment with three similar doses (weeks 0,2, and 6). Those who responded to retreatment were included in a long-term maintenance programme (n=44), with repeated doses (5 mg/kg i.v. infusions) every eight weeks for 1-2 years. Results: in the initial treatment 56% of the patients responded partially; this response being complete in 44%. In the retreatment, 28% of group 1 (non-responders) presented a complete response, compared to 77% in group 2 (relapsers) (p< 0.0001). In the maintenance treatment, the global response was 88% (39/44). The mean number of doses per patient was 4.4 &plusmn; 2 (range 1-9) with a duration of 36 &plusmn; 12 weeks (range 8-72). Adverse effects were not significantly increased in either treatment. Conclusions: both retreatment and long-term maintenance therapy with infliximab, are highly effective and well tolerated in fistulizing Crohn' disease patients.