Loss of response to scheduled infliximab therapy for Crohn's disease in adults: A systematic review and meta‐analysis

• Published in: Journal of digestive diseases Vol. 20; no. 2; pp. 65 - 72
• Main Authors: Zhang, Qi Wei, Shen, Jun, Zheng, Qing, Ran, Zhi Hua
• Format: Journal Article
• Language: English
• Published: Melbourne Wiley Publishing Asia Pty Ltd 01.02.2019; Wiley Subscription Services, Inc
• Subjects: Colon; Crohn disease; Crohn's disease; Crohns disease; Immunotherapy; Infliximab; loss of response; Meta-analysis; Monoclonal antibodies; Risk factors; TNF inhibitors; Tumor necrosis factor-α; meta-analysis; Loss of response; infliximab; Crohn’s disease
• ISSN: 1751-2972; 1751-2980
• DOI: 10.1111/1751-2980.12698

Objective To determine the potential predictors of loss of response (LOR) to infliximab (IFX) maintenance therapy for adult patients with Crohn's disease (CD). Methods We searched for English‐language articles published between 1990 and March 2017 in PubMed, Embase, and the Cochrane Library. After identifying eligible studies, data extraction was performed independently by two reviewers. The potential prognostic variables were identified and dichotomized for meta‐analysis. Based on the heterogeneity among study variables, random‐effects models was used in our meta‐analysis. Results Twenty‐six studies met our eligibility criteria and consolidated drug response data were obtained from 3212 patients. The pooled rate of LOR to IFX maintenance therapy with a median follow‐up of 1.1 years was 34%. The incidence of LOR to IFX therapy was increased in CD patients with perianal lesions (odds ratio [OR] 1.69, 95% confidence interval [CI] 1.04‐2.75, P = 0.03), colon involvement (OR 2.56, 95% CI 1.20‐5.50, P = 0.02) and younger age at CD onset (standardized mean difference −0.79, 95% CI −1.41 to −0.18, P = 0.01). Conclusions The meta‐analysis estimates the incidence of LOR among adult CD patients undergoing IFX therapy is 34%. The presence of perianal lesions, younger age at CD onset, and involvement of the colon are relative risk factors of LOR in CD patients received scheduled IFX maintenance therapy.