- 作者：Dario Sorrentino?/sup> ; sorrentino@uniud.it ; Alberto Paviotti?/sup> ; Giovanni Terrosu&Dagger ; ; Claudio Avellini§ ; ; Marco Geraci?/sup> ; Dimitra Zarifi?/sup>
- 关键词：Crohn's Disease ; Postoperative Recurrence ; Prevention ; Infliximab
- 刊名：Clinical Gastroenterology and Hepatology
- 出版年：2010
- 出版时间：July 2010
- 年：2010
- 卷：8
- 期：7
- 页码：591-599.e1
- 全文大小：2830 K
Background & Aims
Infliximab might prevent postsurgical recurrence of Crohn's disease. However, it is unclear whether long-term therapy is necessary and whether alternative strategies could be applied to minimize potential side effects and reduce the costs of treatment.Methods
We performed a prospective cohort study in 12 consecutive patients, treated immediately after surgery with maintenance infliximab (5 mg/kg), who did not have clinical or endoscopic evidence of disease recurrence after 24 months; they were followed up for an additional year. Infliximab treatment was then discontinued; patients with disease recurrence, based on endoscopy (Rutgeerts score, ?), were given lower doses of infliximab (starting with 1 mg/kg) to re-establish mucosal integrity. Surrogate markers of disease activity (fecal calprotectin [FC], C-reactive protein, and erythrocyte sedimentation rate) were assessed after each infliximab dose.
Results
None of the patients had clinical or endoscopic recurrence of Crohn's disease 3 years after surgery. However, discontinuation of infliximab caused endoscopic recurrence after 4 months in 10 of 12 patients (83 % ). All 10 patients then were treated again with infliximab, which, at a dose of 3 mg/kg every 8 weeks, restored and maintained mucosal integrity for 1 year. Among the surrogate markers, FC levels correlated with endoscopic scores (Wald test, P < .0001).
Conclusions
Long-term maintenance therapy with infliximab is required to maintain mucosal integrity in patients after surgery for Crohn's disease. However, a dose of 3 mg/kg (a 40 % reduction from the standard dose) was sufficient to avoid disease recurrence, determined by endoscopy, in all patients at 1 year. FC levels correlate with mucosal status at different infliximab doses.