Infliximab as Rescue Therapy for Hospitalized Patients With Crohnʼs Disease Failing Intravenous Corticosteroids

Introduction: Infliximab (IFX) has been shown to be effective rescue therapy for ulcerative colitis in hospitalized patients failing intravenous (IV) corticosteroids (CS). However there is little evidence describing its use in similar hospitalized Crohn's Disease (CD) patients. Our aim was to determine if IFX is effective rescue therapy for corticosteroid (CS) resistant CD in hospitalized patients. Methods: All in-patients with CD who received IFX as rescue therapy at Northshore University and Long Island Jewish hospitals from 2007 to 2016 were selected. Records were reviewed for demographics, Montreal classification of CD, pre-admission and inpatient treatment, surgical rates, and 30 and 90-day readmission rates. Only patients failing IV CS prior to IFX were included in the final analysis.Table: Table. Patient DemographicsTable: Table. Dosage of intravenous corticosteroid and infliximab administered during hospitalizationResults: A total of 40 patients received IFX, of which 17 had failed IV CS. Patient demographics are listed in table 1. Mean hospital stay was 9.8 days (range 4 to 30). At admission, 55% were taking oral CS (n=9). Four patients were on outpatient IFX therapy, but still received IV CS during hospitalization prior to IFX. Doses of IV CS and IFX are listed in table 2. The mean duration of IV CS therapy before IFX was 6.9 days (range 4 to 18). Two patients failed IFX and required surgery including a colectomy for pan-colitis with spontaneous perforation, and an ileocolectomy for terminal ileal stricture. Neither patient had received IFX as an outpatient. Of the 15 patients who responded to rescue IFX, the median duration of hospital stay following IFX was 3 days (range 3 to 18 days). Re-admission rates were 29% and 47% at 30 and 90 days respectively, without further surgeries noted. Conclusion: In our series severe CD patients failing IV CS treated with IFX had low rates of urgent surgery and a generally rapid response to treatment, supporting IFX as an effective rescue therapy. By only including those with prior failure of IV CS, we have likely excluded patients for whom IFX was given in the hospital for reasons other than severe disease. Our results suggest that even individuals with severe acute CD flare can be treated with early introduction of IFX, avoiding prolonged CS use and hospitalization. With more biologic therapies becoming available, further trials are needed to assess the efficacy of IFX and newer agents to correctly position rescue therapies for severe CD.

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