Low-dose maintenance therapy with infliximab prevents postsurgical recurrence of Crohn's disease

Clin Gastroenterol Hepatol. 2010 Jul;8(7):591-9.e1; quiz e78-9. doi: 10.1016/j.cgh.2010.01.016. Epub 2010 Feb 4.


Background & aims: Infliximab might prevent postsurgical recurrence of Crohn's disease. However, it is unclear whether long-term therapy is necessary and whether alternative strategies could be applied to minimize potential side effects and reduce the costs of treatment.

Methods: We performed a prospective cohort study in 12 consecutive patients, treated immediately after surgery with maintenance infliximab (5 mg/kg), who did not have clinical or endoscopic evidence of disease recurrence after 24 months; they were followed up for an additional year. Infliximab treatment was then discontinued; patients with disease recurrence, based on endoscopy (Rutgeerts score, >or=2), were given lower doses of infliximab (starting with 1 mg/kg) to re-establish mucosal integrity. Surrogate markers of disease activity (fecal calprotectin [FC], C-reactive protein, and erythrocyte sedimentation rate) were assessed after each infliximab dose.

Results: None of the patients had clinical or endoscopic recurrence of Crohn's disease 3 years after surgery. However, discontinuation of infliximab caused endoscopic recurrence after 4 months in 10 of 12 patients (83%). All 10 patients then were treated again with infliximab, which, at a dose of 3 mg/kg every 8 weeks, restored and maintained mucosal integrity for 1 year. Among the surrogate markers, FC levels correlated with endoscopic scores (Wald test, P < .0001).

Conclusions: Long-term maintenance therapy with infliximab is required to maintain mucosal integrity in patients after surgery for Crohn's disease. However, a dose of 3 mg/kg (a 40% reduction from the standard dose) was sufficient to avoid disease recurrence, determined by endoscopy, in all patients at 1 year. FC levels correlate with mucosal status at different infliximab doses.

MeSH terms

  • Adult
  • Antibodies, Monoclonal / administration & dosage*
  • Biomarkers / analysis
  • Biomarkers / blood
  • Blood Sedimentation
  • C-Reactive Protein / analysis
  • Cohort Studies
  • Crohn Disease / diagnosis
  • Crohn Disease / drug therapy*
  • Crohn Disease / prevention & control
  • Crohn Disease / surgery*
  • Feces / chemistry
  • Female
  • Follow-Up Studies
  • Humans
  • Immunologic Factors / administration & dosage*
  • Infliximab
  • Leukocyte L1 Antigen Complex / analysis
  • Male
  • Middle Aged
  • Prospective Studies
  • Secondary Prevention
  • Treatment Outcome


  • Antibodies, Monoclonal
  • Biomarkers
  • Immunologic Factors
  • Leukocyte L1 Antigen Complex
  • C-Reactive Protein
  • Infliximab