| Theme | How Do You Choose Treatment Strategies for IBD Patients with a Critical Situation? | |
|---|---|---|
| Title | "Loss of Response" to Infliximab in Patients with Crohn's Disease and Its Management | |
| Publish Date | 2016/06 | |
| Author | Hiroki Tanaka | IBD Center, Sapporo Kosei General Hospital |
| Author | Maki Miyakawa | IBD Center, Sapporo Kosei General Hospital |
| Author | Masanao Nasuno | IBD Center, Sapporo Kosei General Hospital |
| Author | Satoshi Motoya | IBD Center, Sapporo Kosei General Hospital |
| [ Summary ] | Loss of response (LOR) can occur in approximately 37 % of patients with Crohn's disease in response to 5 mg/kg infliximab （IFX） maintenance therapy. Although the mechanism responsible for LOR is uncertain, one possibility is the decrease in IFX trough levels by various factors, including the production of antibodies to IFX (ATIs). As immunomodulators elevate IFX trough levels by inhibiting the production of ATIs, a combination therapy with IFX and immunomodulators is considered to be useful in preventing LOR. Therefore, the concomitant use of immunomodulators from the early phase of IFX administration is highly desirable. When LOR occurs, physicians must remember to identify the lesion that requires surgery before considering replacement of the IFX treatment. For cases with LOR, physicians should consider increasing the IFX dose from 5 to 10 mg/kg before switching to adalimumab therapy and adopting this as the first‒line treatment. Approximately 60 % of cases appear to respond to long‒term IFX therapy by increasing the dose to 10 mg/kg. | |