Mucosal healing in ileocolonic Crohn′s diseases with short-term infliximab and immunosuppression combined therapy / 中华消化杂志

ABSTRACT

Objective To investigate the efficacy of short-term biological agent infliximab and immunosuppression combined therapy in patients with active ileocolonic Crohn′s diseases (CD)and to evaluate the mucosal healing.Methods From January 2013 to July 2014,forty hospitalized patients with active ileocolonic CD received at least six times scheduled infliximab injection were enrolled.At week 0, second,and sixth,infliximab 5 mg/kg was administered to induce remission.From the second week, immunosuppression was added.After that,infliximab 5 mg/kg was administered every eight weeks for maintenance treatment.The 36th week after treatment was the end point of follow-up.Before treatment and at the end point of follow-up,the levels of C-reactive protein (CRP),hemoglobin (Hb),clinical remission Crohn′s disease activity index (CDAI)2 ) and deep remission (achieved both clinical remission and mucosal healing)were compared.T test and Wilcoxon rank sum test were performed for comparison before and after treatment.Results At the 36 th week after treatment,the clinical remission rate was 95 .0% (38/40 ),mucosal healing rate,partial mucosal healing rate and deep remission rate were 62.5 % (25/40),35 .0% (14/40)and 62.5 % (25/40), respectively.The mucosal inflammation of only one case (2.5 %)was not improved.After treatment,the CDAI was 99.3 ±29.3,which was lower than that before treatment (301 .3 ±73.1 )and the difference was statistically significant (t = 17.2,P <0.01 ).Median blood CRP level was 0.8 mg/L(0.1 mg/L, 8.1 mg/L),which was lower than that before treatment (26.8 mg/L(16.1 mg/L,61 .0 mg/L)),the difference was statistically significant (Z = - 5 .3,P < 0.01 ).However,the level of Hb ((134.0 ± 16.0)g/L)was higher than that before treatment ((117.0 ±20.0)g/L),the difference was statistically significant (t=-6.3,P <0.01 ).The median SES-CD was 0 (0,5 ),which was lower than that before treatment (14(8,24)),and the difference was statistically significant (Z =-5 .4,P <0.01 ).Conclusion The short-term (36 weeks)infliximab and immunosuppression combined therapy can achieve high mucosal healing rate and deep remission rate in active ileocolonic CD patients.