Endoscopic Monitoring of Infliximab Therapy in Crohn's Disease

Background: So far, infliximab (IFX) therapy for the treatment of Crohn's disease (CD) has generally been guided by clinical symptoms. Data on treatment response as ascertained by endoscopy in IFX therapy are scarce. The aims of this study were to measure the endoscopic response rate during IFX induction and maintenance therapy in luminal CD, and also evaluate the role of endoscopy in monitoring IFX therapy. Methods: Data obtained from 71 patients with active luminal CD and treated with IFX were analyzed retrospectively. The endoscopy findings were scored according to mucosal activity as: 0 (remission), 1-2 (mild), 3-4 (moderate), and 5-6 (severe). A positive endoscopic response was determined by a decrease in score of at least two points and mucosal healing was assigned a score of between 0-2. Results: At baseline all patients presented with moderate or severe luminal inflammation. A positive endoscopic response occurred in 73% of patients at 3 months and when IFX was continued, the endoscopic response was maintained in 77% of these patients at 12 months. Mucosal healing at first follow-up endoscopy was documented in 45% of patients and was highly predictive for its persistence at 12 months, maintained in 90% of patients, when IFX was continued. Conclusions: Endoscopy at 3 months from the start of IFX therapy helps to predict responders to IFX for maintenance therapy in active luminal CD.