Infliximab reintroduction is not associated to a higher rate of immune-related adverse effects in patients with inflammatory bowel disease initially treated with a three-infusion induction regimen

Background: Episodic infliximab (IFX) treatment is associated with a higher risk for acute infusion reactions (AIR) and secondary loss of response (SLR), but this has not been evaluated in patients initially treated with an induction regimen with 3 IFX infusions. Aims: To evaluate whether IFX reintroduction after ≥4 months in patients treated with a 3-infusion induction regimen is associated with a higher incidence of AIR or SLR. Methods: Incidence of immunogenic adverse effects was assessed in patients with inflammatory bowel disease who received ≥4 consecutive IFX infusions (3 infusions at weeks 0, 2, and 6, plus ≥1 maintenance infusion) (Continuous, n=47) and patients who were treated with a successful initial 3-infusion induction scheme and in whom IFX was then discontinued because of a complete response but reintroduced ≥4 months later (Reintro, n=29). Results: AIR rate was 17% in both groups, and SLR rate was 26% in the Continuous group and 15% in the Reintro group (not significant). The lack of concomitant immunomodulators and/or pretreatment with hydrocortisone were associated with AIR development (P=0.002). Conclusions: In patients who completed a 3-infusion induction regimen, IFX can be safely reintroduced even after a long time from discontinuation. Copyright © 2009 by Lippincott Williams & Wilkins.