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Mucosal healing predicts long-term outcome of maintenance therapy with infliximab in Crohn's disease

F Schnitzler, H Fidder, M Ferrante, M Noman, I Arijs, G Van Assche, I Hoffman, Kristel Van Steen (UGent) , S Vermeire and P Rutgeerts
(2009) INFLAMMATORY BOWEL DISEASES. 15(9). p.1295-1301
Author
Organization
Abstract
Background: Infliximab (IFX) treatment induces mucosal healing (MH) in patients with Crohn's disease (CD) but the impact of MH oil the long-term outcome of IFX treatment in CID is still debated. Methods: We studied MH during long-term treatment with IFX in 214 CID patients. A total of 193 patients (85.5%) responded to induction therapy and 31 patients (14.5%) were primary nonresponders. They underwent lower gastrointestinal (GI) endoscopy within a median of 0.7 months (interquartile range [IQR] 0.1-6.9) prior to first IFX and after a median of 6.7 months (IQR 1.4-24.6) after start of IFX and were further analyzed. The relationship between the outcome of IFX treatment long-term and MH was studied. Results: MH was observed in 67.8% of the 183 initial responders (n = 124), with 83 patients having complete healing (45.4%) and 41 having partial healing (22.4%). Scheduled IFX treatment from the start resulted in MH more frequently (76.9% MH rate) than episodic treatment (61.0% MH rate; P = 0.0222, odds ratio [OR] 2.14, 95% confidence interval [CI] 1.11-4.12). Concomitant treatment with corticosteroids (CS) had a negative impact on MH (37.9% in patients with CS versus 63.2% in patients without CS; P = 0.021, OR 0.36, 95% CI 0.16-0.80). MH was associated with a significantly lower need for major abdominal surgery (MAS) during long-term follow-up (14.1% of patients with MH needed MAS versus 38.4% of patients Without MH: P < 0.0001). Conclusions: MH induced by long-term maintenance IFX treatment is associated with an improved long-term outcome of the I disease especially with a lower need for major abdominal surgeries.
Keywords
INFLAMMATORY-BOWEL-DISEASE, RANDOMIZED-TRIAL, AZATHIOPRINE, EVOLUTION, BEHAVIOR, Crohn's disease, infliximab, mucosal healing, changing disease course, long-term endoscopic outcome

Citation

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MLA
Schnitzler, F., et al. “Mucosal Healing Predicts Long-Term Outcome of Maintenance Therapy with Infliximab in Crohn’s Disease.” INFLAMMATORY BOWEL DISEASES, vol. 15, no. 9, 2009, pp. 1295–301, doi:10.1002/ibd.20927.
APA
Schnitzler, F., Fidder, H., Ferrante, M., Noman, M., Arijs, I., Van Assche, G., … Rutgeerts, P. (2009). Mucosal healing predicts long-term outcome of maintenance therapy with infliximab in Crohn’s disease. INFLAMMATORY BOWEL DISEASES, 15(9), 1295–1301. https://doi.org/10.1002/ibd.20927
Chicago author-date
Schnitzler, F, H Fidder, M Ferrante, M Noman, I Arijs, G Van Assche, I Hoffman, Kristel Van Steen, S Vermeire, and P Rutgeerts. 2009. “Mucosal Healing Predicts Long-Term Outcome of Maintenance Therapy with Infliximab in Crohn’s Disease.” INFLAMMATORY BOWEL DISEASES 15 (9): 1295–1301. https://doi.org/10.1002/ibd.20927.
Chicago author-date (all authors)
Schnitzler, F, H Fidder, M Ferrante, M Noman, I Arijs, G Van Assche, I Hoffman, Kristel Van Steen, S Vermeire, and P Rutgeerts. 2009. “Mucosal Healing Predicts Long-Term Outcome of Maintenance Therapy with Infliximab in Crohn’s Disease.” INFLAMMATORY BOWEL DISEASES 15 (9): 1295–1301. doi:10.1002/ibd.20927.
Vancouver
1.
Schnitzler F, Fidder H, Ferrante M, Noman M, Arijs I, Van Assche G, et al. Mucosal healing predicts long-term outcome of maintenance therapy with infliximab in Crohn’s disease. INFLAMMATORY BOWEL DISEASES. 2009;15(9):1295–301.
IEEE
[1]
F. Schnitzler et al., “Mucosal healing predicts long-term outcome of maintenance therapy with infliximab in Crohn’s disease,” INFLAMMATORY BOWEL DISEASES, vol. 15, no. 9, pp. 1295–1301, 2009.
@article{5907086,
  abstract     = {{Background: Infliximab (IFX) treatment induces mucosal healing (MH) in patients with Crohn's disease (CD) but the impact of MH oil the long-term outcome of IFX treatment in CID is still debated. 
Methods: We studied MH during long-term treatment with IFX in 214 CID patients. A total of 193 patients (85.5%) responded to induction therapy and 31 patients (14.5%) were primary nonresponders. They underwent lower gastrointestinal (GI) endoscopy within a median of 0.7 months (interquartile range [IQR] 0.1-6.9) prior to first IFX and after a median of 6.7 months (IQR 1.4-24.6) after start of IFX and were further analyzed. The relationship between the outcome of IFX treatment long-term and MH was studied. 
Results: MH was observed in 67.8% of the 183 initial responders (n = 124), with 83 patients having complete healing (45.4%) and 41 having partial healing (22.4%). Scheduled IFX treatment from the start resulted in MH more frequently (76.9% MH rate) than episodic treatment (61.0% MH rate; P = 0.0222, odds ratio [OR] 2.14, 95% confidence interval [CI] 1.11-4.12). Concomitant treatment with corticosteroids (CS) had a negative impact on MH (37.9% in patients with CS versus 63.2% in patients without CS; P = 0.021, OR 0.36, 95% CI 0.16-0.80). MH was associated with a significantly lower need for major abdominal surgery (MAS) during long-term follow-up (14.1% of patients with MH needed MAS versus 38.4% of patients Without MH: P < 0.0001). 
Conclusions: MH induced by long-term maintenance IFX treatment is associated with an improved long-term outcome of the I disease especially with a lower need for major abdominal surgeries.}},
  author       = {{Schnitzler, F and Fidder, H and Ferrante, M and Noman, M and Arijs, I and Van Assche, G and Hoffman, I and Van Steen, Kristel and Vermeire, S and Rutgeerts, P}},
  issn         = {{1078-0998}},
  journal      = {{INFLAMMATORY BOWEL DISEASES}},
  keywords     = {{INFLAMMATORY-BOWEL-DISEASE,RANDOMIZED-TRIAL,AZATHIOPRINE,EVOLUTION,BEHAVIOR,Crohn's disease,infliximab,mucosal healing,changing disease course,long-term endoscopic outcome}},
  language     = {{eng}},
  number       = {{9}},
  pages        = {{1295--1301}},
  title        = {{Mucosal healing predicts long-term outcome of maintenance therapy with infliximab in Crohn's disease}},
  url          = {{http://dx.doi.org/10.1002/ibd.20927}},
  volume       = {{15}},
  year         = {{2009}},
}
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