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Infliximab trough serum level predicts outcomes in Crohn’s disease (CD).  Maser et al. measured trough serum levels of infliximab in 105 patients with CD treated with infliximab induction (5 mg/kg) followed by either episodic (n = 23) or scheduled (n = 82) maintenance infliximab therapy at 6- to 8-week intervals. After a median follow-up of 23 months, clinical remission was observed to be significantly higher in patients with a detectable infliximab serum trough level than in patients in whom the infliximab serum trough level was undetectable (82% vs. 6%). Patients with detectable infliximab serum trough levels also had lower C-reactive protein levels (P<0.001) and a higher rate of endoscopic improvement (P<0.001). Episodic infliximab maintenance therapy was associated with a higher rate of antibody formation (39% vs. 16%) and a higher rate of infusion reactions (50% vs. 21%). These results support the use of induction and maintenance schedules of infusions to maintain detectable trough concentrations of infliximab that translate into improved clinical outcomes.  (Maser EA, et al. Clin Gastroenterol Hepatol .2006;4:1248–1254)

Transplacental transfer of infliximab.  Although small series of infliximab use during pregnancy have reported favorable fetal and maternal outcomes, there is heightened concern over the treatment of pregnant patients with infliximab due to recent labeling changes. In the current case study, Vasiliauskas and others measured infliximab levels in the newborn of a 23-year-old mother with CD treated with infliximab throughout pregnancy (5 infusions of infliximab 10 mg/kg; last infusion administered 2 weeks before delivery). At 6 weeks after delivery, the infant’s serum infliximab concentration was 39.5 μg/mL. Infliximab was not detected in breast milk. The infant’s serum levels of infliximab declined gradually over the following 6 months despite continued breast-feeding and subsequent maternal infliximab re-treatments. These findings suggest that the high infliximab levels in the serum of this infant were due to placental transfer. The half-life of infliximab was prolonged in this newborn. The implications of infliximab exposure during the newborn period are unknown. Patients and physicians must be informed about in utero exposure to infliximab.  (Vasiliauskas EA, et al. Clin Gastroenterol Hepatol. 2006;4:1255–1258)

Surgical vs. percutaneous drainage of abdominal and pelvic abscesses.  A. Gutierrez and colleagues reviewed the outcomes among CD patients treated for abdominal and pelvic abscesses at the Massachusetts General Hospital (Boston, Mass.) from 1991 to 2001. A total of 66 episodes were identified that had been treated by surgical (n = 29) or percutaneous (n = 37) drainage. The median time to abscess resolution was found to be similar in patients receiving either surgical or percutaneous drainage therapy (25.0 vs. 21.5 days). A Cox regression model identified the number of days from onset of symptoms to radiographic diagnosis or drainage to be the only independent factor associated with time to abscess resolution. Older age, absence of fistulas, immune modulator therapy, absence of rebound tenderness, and admission to the medical service were not found to affect the time to resolution. These data indicate that early intervention is associated with shorter time to resolution of abdominal and pelvic abscesses in CD patients.  (Gutierrez A, et al. Am J Gastroenterol. 2006;101:2283–2289)

Capsule endoscopy retention.  Small bowel obstruction is considered by many to be a contraindication to capsule endoscopy.  Cheifetz and Lewis retrospectively reviewed clinical data from 568 capsule endoscopy evaluations performed between 2001 and 2003 at the Beth Israel Deaconess Medical Center (Boston, Mass.). They identified 19 cases in which capsule endoscopy was used in the setting of suspected small bowel obstruction. Capsule endoscopy confirmed the diagnosis of small bowel obstruction in 5 cases, and the capsule was retained proximal to a stricture in 4 cases. In all 4 cases, the obstructing lesion was electively resected without complication. In no case did the introduction of the capsule lead to an acute small bowel obstruction. These data suggest that capsule endoscopy can be safely used to identify the etiology and site of a small bowel obstruction. Capsule retention may indicate the presence of a lesion that requires surgery, but it may lead to surgery in a patient who may have otherwise been treated medically.  (Cheifetz AS, Lewis BS. J Clin Gastroenterol. 2006;40:688–691)

Methotrexate (MTX) in pediatric CD patients.  Uhlen and coworkers retrospectively reviewed data from three French centers concerning the use of MTX in 61 children with active CD. The indications for the use of MTX were relapsed/refractory disease following azathioprine treatment (n = 42) or intolerance to azathioprine (n = 19). MTX improved or induced complete remission in 49 patients (80%). Complete remission was observed in 39%, 49%, and 45% of children at 3, 6, and 12 months, respectively.  Sustained remissions of up to 40 months were achieved and corticosteroids were discontinued in 36 patients. Adverse events were reported in 14 children (24%) and caused discontinuation of MTX in 6 children (10%). These results indicate that MTX may represent an effective and safe treatment for pediatric patients with CD.  (Uhlen S, et al. Inflamm Bowel Dis. 2006;12:1053–1057)

Cytomegalovirus (CMV) colitis.  Kandiel and Lashner provide a review of CMV colitis complicating IBD. IBD patients are often immunosuppressed and are at an increased risk for CMV infection. Concurrent CMV infection is often considered in IBD patients hospitalized with a flare of acute severe colitis. The prevalence of CMV infection in acute severe colitis is 21% to 34% overall and is 33% to 36% in the subgroup of patients with steroid-refractory disease. Antiviral therapy results in colitis remission rates of 67% to 100%. CMV histologic infection or the presence of circulating virus alone is not always associated with steroid resistance and may not require antiviral therapy.  (Kandiel A, Lashner B. Am J Gastroenterol. 2006; Epub ahead of print)

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