Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website http://www.jocmr.org

Original Article

Volume 10, Number 2, April 2017, pages 92-99


Discontinuation of Scheduled Infliximab in Crohn’s Patients With Clinical Remission: A Retrospective Single-Center Study

Figures

Figure 1.
Figure 1. Study population. IFX: infliximab.
Figure 2.
Figure 2. The rate of remission after infliximab withdrawal in patients with Crohn’s disease.

Tables

Table 1. Characteristics of the Included Patients
 
CharacteristicsCD patients (n = 106)
CRP: C-reactive protein; Alb: albumin; WBC: white blood cell; Hb: hemoglobin; Hct: hematocrit; AZA: azathioprine; CDAI: Crohn’s disease activity index; SD: standard deviation; IQR: interquartile range.
Male, n (%)72 (67.9)
Active smoker, n (%)3 (2.8)
Age (years) at diagnosis, mean (SD)26.6 (9.5)
Montreal classification
  Age (years) at diagnosis, n (%)
    ≤ 16 years (A1)10 (9.4)
    17 - 40 years (A2)83 (78.3)
    > 40 years (A3)13 (12.3)
  Disease site, n (%)
    Ileum (L1)36 (34.0)
    Colon (L2)7 (6.6)
    Ileocolon (L3)63 (59.4)
  Disease behavior, n (%)
    Inflammatory (B1)55 (51.9)
    Stricturing (B2)41 (38.7)
    Penetrating (B3)10 (9.4)
  Perianal disease, n (%)28 (26.4)
Extraintestinal manifestations, n (%)10 (9.4)
Disease duration (m), n (%)
  ≤ 1884 (79.2)
  > 1822 (20.8)
Gastrointestinal surgery before infusion, n (%)27 (25.5)
Therapeutic regimen, n (%)
  Step-up30 (28.3)
  Top-down76 (71.7)
CRP level at week 0/30, median (IQR)9.9 (3.0 - 38.9)/1.49 (0.48 - 6.11)
Alb level at week 0/30, median (IQR)37.7 (33.7 - 41.6)/42.3 (39.2 - 45.7)
WBC level at week 0/30, median (IQR)7.12 (5.91 - 8.92)/5.57 (4.83 - 6.58)
Hb level at week 0/30, median (IQR)115.0 (101.0 - 130.3)/129.0 (117.5 - 143.0)
Hct level at week 0/30, median (IQR)36.6 (32.7 - 40.5)/39.3 (35.9 - 43.2)
CDAI at week 0/30, median (IQR)213.5 (160.0 - 265.3)/64.5 (39.8 - 90.5)
AZA at IFX discontinuation, n (%)77 (72.6)

 

Table 2. Univariate Analysis of Factors Associated With Relapse
 
VariablesRelapses/totalP valueHazard ratio95% CI
CRP: C-reactive protein; Alb: albumin; Hb: hemoglobin; AZA: azathioprine; CI: confidence interval. *Male patients < 130 g/L, female patients < 115 g/L. **Male patients < 0.4, female patients < 0.35.
Sex
  Female18/340.6051
  Male41/721.1580.664 - 2.017
Disease duration (months)
  ≤ 1842/840.0721
  > 1817/221.6790.954 - 2.955
Age at diagnosis
  ≤ 16 years (A1)3/100.0711
  17 - 40 years (A2)46/830.2661.9420.603 - 6.255
  > 40 years (A3)10/130.0453.7631.032 - 13.719
Location
  Ileum (L1)22/360.2671
  Colon (L2)5/70.1851.9440.728 - 5.188
  Ileocolon (L3)32/630.6600.8850.513 - 1.525
  Upper GI (L4)0/0
Behavior
  Inflammatory (B1)25/550.0941
  Stricturing (B2)27/410.0811.6240.942 - 2.800
  Penetrating (B3)7/100.0702.1710.937 - 5.027
Perianal disease
  No45/780.8881
  Yes14/280.9570.524 - 1.751
Extraintestinal manifestation
  No52/960.1681
  Yes7/101.7460.790 - 3.858
Therapeutic regimen
  Top-down37/760.0271
  Step-up22/301.8201.070 - 3.093
Combine therapy
  No48/860.6241
  Yes11/201.1790.611 - 2.272
CD-related surgery before infusion
  No39/790.0491
  Yes20/271.7181.002 - 2.947
Biologic variables at week 0
  Low Hb level* (n = 106)
    No14/380.0041
    Yes45/682.4191.325 - 4.416
  Low Hct level** (n = 106)
    No17/410.0201
    Yes42/651.9551.112 - 3.438
  CRP level (mg/L) (n = 101)
    ≤ 520/370.8981
    > 536/641.0360.600 - 1.791
  Alb level (g/L) (n = 102)
    ≥ 4015/380.0271
    < 4041/641.9551.081 - 3.535
Biologic variables at week 30
  Low Hb level* (n = 105)
    No33/660.2771
    Yes25/391.3350.793 - 2.245
  Low Hct level** (n = 105)
    No28/620.0091
    Yes30/431.9921.188 - 3.341
  CRP level (mg/L) (n = 93)
    ≤ 530/680.0001
    > 521/253.4791.979 - 6.114
  Alb level (g/L) (n = 99)
    ≥ 4027/660.0001
    < 4026/332.7171.567 - 4.711
AZA after IFX discontinuation
  No14/290.1091
  Yes45/771.6440.896 - 3.018

 

Table 3. Multivariable Cox Model
 
VariablesP valueHazard ratio95% CI
After univariate analysis, variables with P < 0.05 were included in the multivariable Cox model. CRP: C-reactive protein; Alb: albumin; CI: confidence interval.
CD-related surgery before infusion0.0132.6711.230 - 5.798
Step-up therapeutic regimen0.0352.0731.054 - 4.080
Low Hb level at week 00.1162.1830.825 - 5.779
Low Hct level at week 00.4390.6780.253 - 1.817
Low Alb level at week 00.0223.4311.196 - 9.846
Low Hct level at week 300.5311.2580.613 - 2.582
High CRP level at week 300.0072.6431.310 - 5.332
Low Alb level at week 300.8190.9160.434 - 1.935