Serious infection and mortality in patients with Crohn's disease: more than 5 years of follow-up in the TREAT™ registry.

Abstract

OBJECTIVES:

The objective of this study was to contribute long-term safety data for infliximab and other therapies in Crohn's disease (CD).

METHODS:

We prospectively evaluated CD patients enrolled in the large, observational Crohn's Therapy, Resource, Evaluation, and Assessment Tool registry, established to compare infliximab safety with conventional nonbiological medications in CD.

RESULTS:

A total of 6,273 patients were enrolled and evaluated on or before 23 February 2010; 3,420 received infliximab (17,712 patient-years; 89.9% received ≥ 2 infusions) and 2,853 received other-treatments-only (13,251 patient-years). Mean length of patient follow-up was 5.2 years. More infliximab- than other-treatments-only-treated patients had moderate-to-severe (30.6% vs. 10.7%) or severe-to-fulminant (2.5% vs. 0.6%) disease severity (P < 0.001). In the year before enrollment, more infliximab- than other-treatments-only-treated patients required surgical intervention (17.4% vs. 13.6%), medical hospitalization (14.2% vs. 8.8%), prednisone (47.8% vs. 31.4%), immunomodulators (52.0% vs. 32.1%), and narcotic analgesics (17.3% vs. 9.1%). Patient mortality was similar for infliximab- and other-treatments-only-treated patients (0.58 vs. 0.59/100 patient-years). In multivariate logistic regression analyses, treatment with prednisone (hazard ratio (HR) = 2.14, 95% confidence interval (CI) = 1.55, 2.95; P < 0.001) or narcotic analgesics (HR = 1.79, 95% CI = 1.29, 2.48; P < 0.001) and age (HR = 1.08, 95% CI = 1.07, 1.09; P < 0.001) were associated with increased mortality risk. Neither infliximab nor immunomodulator treatment was associated with increased mortality risk. Factors independently associated with serious infections included moderate-to-severe disease activity (HR = 2.24, 95% CI = 1.57, 3.19; P < 0.001), narcotic analgesic treatment (HR = 1.98, 95% CI = 1.44, 2.73; P < 0.001), prednisone therapy (HR = 1.57, 95% CI = 1.17, 2.10; P = 0.002), and infliximab treatment (HR = 1.43, 95% CI = 1.11, 1.84; P = 0.006).

CONCLUSIONS:

Mortality was similar between infliximab- and other-treatments-only-treated CD patients. An increased risk of serious infection with infliximab was observed, although CD severity and use of prednisone or narcotic analgesics carried higher risks.

• Authors: Gary R Lichtenstein, Brian G Feagan, Russell D Cohen, Bruce A Salzberg, Robert H Diamond, Samiyeh Price, Wayne Langholff, Anil Londhe, William J Sandborn
• Journal: The American journal of gastroenterology (Am J Gastroenterol) Vol. 107 Issue 9 Pg. 1409-22 (Sep 2012) ISSN: 1572-0241 [Electronic] United States
• PMID: 22890223 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal
• Gastrointestinal Agents
• Immunosuppressive Agents
• Infliximab
• Prednisone

Topics

• Adult
• Antibodies, Monoclonal (adverse effects, therapeutic use)
• Crohn Disease (drug therapy, mortality)
• Female
• Follow-Up Studies
• Gastrointestinal Agents (adverse effects, therapeutic use)
• Humans
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Infections (epidemiology)
• Infliximab
• Male
• Middle Aged
• Prednisone (adverse effects, therapeutic use)
• Prospective Studies
• Registries
• Severity of Illness Index
• Treatment Outcome