Mid-term impact of infliximab metaoptimization on surgical rates in severe inflammatory bowel disease: 3-year follow up ; Impact à moyen terme de l’optimisation de l’infliximab sur la prise en charge chirurgicale des formes sévères des maladies inflammatoires chroniques de l’intestin après trois ans de suivi

Background: severe IBD patients are prone to increased drug clearance via accelerated drug metabolism as well as excess loss through fecal excretion and may require higher doses of infliximab (IFX) to achieve appropriate pharmacokinetics and drug concentrations. Exactly how to optimize accelerated dosing strategies remains an unanswered question. Method: Our aim was to evaluate the efficacy of metaoptimized IFX (MIFX), i.e. combined intensified induction and maintenance regimen as compared to a standard IFX (SIFX) schedule historical cohort on 3-year surgical rates. In this retrospective single center study, two cohorts of patients with CD and UC who were hospitalized at our single teaching hospital for an acute severe flare were identified from 2014 to 2016 (MIFX cohort) and 2007 to 2014 (SIFX cohort) were identified. Severe UC and CD were defined per clinical assessment with a Lichtiger Index > 12 for UC, a Harvey Bradshaw Index (HBI) > 12 for CD and according to ECCO classification. Results: 15/46 (35.6%) MIFX had undergone surgery, against 21/49 (43.8%) in SIFX group, after 3 year of follow up. SIFX patients are 1.6-fold chance of not being surgery-free at 3 year than MIFX patients (OR 1.6 [95% IC: 0.633-4.255], p=0.308). Conclusion: Our study suggests that, in our real-life practice, severe selected IBD patients with IFX metaoptimization had more persistent and higher chance of being surgery-free at the mid-term without carrying an increased risk for infection. ; Contexte : Les maladies intestinales inflammatoires provoquent des lésions digestives qui peuvent nécessiter une intervention chirurgicale dans les cas graves. Les médicaments anti-TNF réduisent les complications de ces maladies, mais certains patients résistent au traitement. Le but de ce travail était de déterminer si l'optimisation de la dose à 10 mg/kg à la semaine zéro, à la semaine 1 puis à la semaine 4 et ensuite toutes les 4 semaines réduisait la nécessité d'une intervention chirurgicale à moyen terme. Méthode : Étude rétrospective de ...