INFLIXIMAB IN THE TREATMENT OF CROHN'S DISEASE: A USER'S GUIDE FOR
CLINICIANS
Induction therapy with infliximab is indicated for treatment of signs and
symptoms, and induction and maintenance of remission in patients with moderate
to severely active inflammatory Crohn’s disease with an inadequate response to
conventional therapy, and for reduction in the number of draining fistulas in
patients with fistulizing Crohn’s disease. Emerging indications for infliximab
therapy in patients with Crohn’s disease include maintenance of fistula
improvement (reduction in the number of draining perianal or enterocutaneous
fistulas) and complete fistula response (no draining fistulas) in patients with
fistulizing Crohn’s disease, steroid sparing in steroid-treated patients, early
use in hospitalized patients who have not failed conventional medical therapy
where there is either a severe clinical presentation or a rapid onset of action
is desired, and in a variety of unusual and extra-intestinal manifestations of
Crohn’s disease. An infliximab dose of 5 mg/kg is recommended initally, but some
patients who require maintenance dosing may benefit from increasing the
infliximab dose over a range of 5–10 mg/kg. An induction regimen of 3 doses at
0, 2, and 6 weeks is the preferred dosing strategy for inducing remission. The
optimal dosing interval for patients who require retreatment appears to be every
8 weeks for most patients. Concomitant immunosuppressive therapy with
azathioprine, 6-mercaptopurine, or methotrexate may result in improved outcomes
due to a reduction in the frequency of human anti-chimeric antibody formation,
acute infusion reactions, and a reduced risk of delayed hypersensitivity-like
reactions and formation of antinuclear antibodies. Pretreatment with
diphenhydramine (and in selected cases of acetaminophen and, rarely,
corticosteroids) is recommended in patients with a history of infusion reactions
and patients at risk for delayed hypersensitivity-like reactions. Patients with
evidence of active infection should not receive infliximab until the infection
is adequately treated, and all patients should be screened for tuberculosis
prior to initiating infliximab therapy