Korean J Gastroenterol.  2009 Aug;54(2):108-116. 10.4166/kjg.2009.54.2.108.

Efficacy of Infliximab in the Treatment of Korean Patients with Crohn's Disease

• Kim SH
• Yang SK
• Kim KJ
• Kim EH
• Yoon SM
• Ye BD
• Byeon JS
• Myung SJ
• Kim JH

• KMID: 1775965
• DOI: http://doi.org/10.4166/kjg.2009.54.2.108

Abstract

BACKGROUND/AIMS
Infliximab has been proven to be effective for refractory luminal and fistulizing Crohn's disease (CD). We performed this study to demonstrate the efficacy of infliximab in Korean CD patients. METHODS: Medical records of 40 CD patients who had been treated with infliximab were reviewed retrospectively. RESULTS: Among 40 patients, 11 (27.5%) patients were treated for refractory luminal disease, 14 (35%) for fistulizing disease, and 15 (37.5%) for both types. Clinical response rate was higher in 26 patients with refractory luminal disease (Complete response (CR), 73.1%; Partial response (PR), 23.1%) than in 29 patients with fistulizing disease (CR, 41.4%; PR, 31%) (p=0.024). The clinical response rate tended to be higher in 28 patients with external fistulas (CR, 46.4%; PR, 32.2%) than 4 patients with internal fistulas (PR, 25%; NR, 75%) (p=0.064). Among patients with external fistulas, the response rate of 8 patients with enterocutaneous fistulas (CR, 50%; PR, 12.5%) was not different from 20 patients with perianal fistulas (CR, 45%; PR, 40%). Among 20 patients with perianal fistulas, the response rate of 6 patients with perianal fistulas without a history of operation (CR, 83.3%; PR, 0%) was higher than 14 patients with perianal fistulas resistant to previous surgical treatment (CR, 28.6%; PR, 57.1%) (p=0.044). As for adverse reaction, 7 patients experienced mild infusion reaction, and 2 patients developed serious infection. CONCLUSIONS: Infliximab is more effective for refractory luminal disease than for fistulizing disease. In addition, clinical responses to infliximab are different according to subtypes of fistulas. These findings should be considered for the proper use of infliximab.

Keyword

Inflammatory bowel disease; Crohn's disease; Infliximab

MeSH Terms

Adolescent
Adult
Antibodies, Monoclonal/*therapeutic use
Asian Continental Ancestry Group
Crohn Disease/*drug therapy
Female
Fistula/*drug therapy
Humans
Immunosuppressive Agents/*therapeutic use
Korea
Male
Middle Aged
Retrospective Studies
Treatment Outcome

Figure

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  Fig. 1. Classification of fistulas.

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  Fig. 2. Response to infliximab in relation to the disease type. Response to infliximab in 26 patients with refractory lumininl disease was better than 29 patients with fistulizing Crohn's disease. CR, complete response; PR, partial response; NR, non-response.

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  Fig. 3. Response to infliximab in relation to the type of fistulas. Patients with external fistulas had a trend toward a better response to inflximab than internal fistulas. However, the difference was not statistically significant. CR, complete response; PR, partial response; NR, non-response.

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  Fig. 4. Response to infliximab in relation to the subtypes of external fistulas. Response to infliximab in patients with perianal fistula was not different from enterocutaneous fistula. CR, complete response; PR, partial response; NR, non-response.

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  Fig. 5. Response of perianal fistulas to infliximab in relation to the history of operation for perianal fistulas. Perianal fistulas without a history of operation responded to infliximab better than those resistant to a previous operation. CR, complete response; PR, partial response; NR, non-response; PAF, perianal fistula.

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