Round 2 of Infliximab for IBD Patients

A recent study published in Clinical Gastroenterology and Hepatology cites the efficacy and safety of resuming infliximab therapy for inflammatory bowel disease (IBD) patients following a drug holiday.

Filip Baert, MD, PhD, Department of Gastroenterology, University Hospitals Leuven, Belgium, and the study’s lead author commented, “Our findings suggest that starting infliximab after a history of prior therapy can be very beneficial to patients. 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.”

Baert and his team conducted a retrospective single-center study of a consecutive series of 132 inflammatory bowel disease (IBD) patients, 109 suffering from Crohn’s disease and the remaining, 23, from ulcerative colitis. Researchers immediately realized; however, 4 Crohn’s disease patients had to be excluded because of insufficient clinical data.

According to reports, patients may initially stop infliximab therapy for multiple reasons, but primarily because of durable remission, pregnancy, safety, financial concerns. Findings did suggest that the most ideal candidates were those 78% who were in remission during the period of infliximab discontinuation. They saw that among patients with prior infusion reaction, 45% responded favorably.

Researchers discovered a great method to help guide physicians in predicting long-term safety of restarting infliximab is simply to ensure regularly check levels of antibodies and other pharmacologic monitoring. While these methods may not always be immediately attainable, the more they are used, the increased possibility for early optimization. The experts were also pleased to note that immunomodulators were successful in protecting patients against all infusion reactions, thereby assuaging any initial doubts of this strategy.

“Clinicians understandably have been reluctant to re-challenge patients with infliximab given the fear of immediate or delayed hypersensitivity reactions with dose interruptions. This study provides the important message that restarting infliximab after a drug holiday is feasible," said Dr. Baert.

While Infliximab was the first anti-tumor necrosis factor (TNF) biologic for Crohn's disease and is still used rather frequently for its efficiency in both Crohn's and ulcerative colitis, previous studies have reported some patients to become unresponsive to the biologics. Future studies will further identify the successful infliximab antibodies that are associated with the safety of resuming the biologic therapy.