Infliximab in clinical routine : experience with Crohns disease and biomarkers of inflammation over 5 years

Introduction Infliximab was launched for the treatment of Crohns disease (CD) in 1999. We set up a follow-up protocol to meticulously study disease development with repeated infusions of infliximab. Aim To follow the effects of infliximab treatment on disease activity, blood chemistry, quality of life, plasma nitrite, and titers of Saccharomyces cerevisiae antibodies (ASCA). Methods During 1999-2008, CD patients were monitored for disease activity by Harvey-Bradshaw index, blood chemistry with hemoglobin, albumin, C-reactive protein, platelet count, leukocyte count and creatinine, quality of life by the Short Health Scale, and plasma nitrite. During the first year of treatment, follow-up was done repeatedly before and 1 week after each infusion and thereafter every year before the last infusion for 5 years. ASCA was analyzed by flow cytometry with fluorescein isothiocyanate-labelled antibodies. Results A total of 1061 infusions were given to 103 patients; 92 responders and 11 nonresponders. Responders were further monitored and Harvey-Bradshaw index decreased with infusions during the first year of treatment (Pandlt;0.0001), whereas hemoglobin (Pandlt;0.01) and albumin (Pandlt;0.001) increased, C-reactive protein (Pandlt;0.01) decreased, platelets (Pandlt;0.001) increased, and leukocytes (Pandlt;0.01) decreased. Creatinine was not affected. Short Health Scale (questions analyzed separately) decreased (Pandlt;0.0001), and nitrite (Pandlt;0.001) increased. During the next 4 years the improved values remained stable. Adverse effects were noted among 32% of the patients; local circulatory reactions being most common. No correlation between ASCA titers and inflammatory activity or infliximab treatment was found. Conclusion Infliximab treatment is highly effective in responders and maintains symptomatic improvement and low inflammatory activity over years in CD patients.