Louis et al identified risk factors for relapse of Crohn's disease following discontinuation of infliximab therapy. These can help to determine whether or not to change therapy in these patients. The authors are from Groupe D'etudes Therapeutiques des Affections Inflammatoires Digestives.
Patient selection: Crohn's disease, treated with infliximab plus an antimetabolite for at least 1 year, corticosteroid free remission for >= 6 months
Outcome: relapse after discontinuation of infliximab (but with continuation of the antimetabolite)
Parameters
(1) gender
(2) history of surgical resection for Crohn's disease
(3) white blood cell count
(4) hemoglobin
(5) CRP
(6) fecal calprotectin
|
Parameter |
Finding |
Points |
|
gender |
female |
0 |
|
|
male |
1 |
|
history of surgical resection |
yes |
0 |
|
|
no |
1 |
|
WBC count |
<= 6,000 per µL |
0 |
|
|
> 6,000 per µL |
1 |
|
hemoglobin |
> 14.5 g/dL |
0 |
|
|
<= 14.5 g/dL |
1 |
|
CRP |
< 5 mg/L |
0 |
|
|
>= 5 mg/L |
1 |
|
fecal calprotectin |
< 300 micrograms per g feces |
0 |
|
|
>= 300 micrograms per g feces |
1 |
total number of risk factors =
= SUM(points for all 6 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 6
• The risk for relapse increases with the number of risk factors.
• For patients with 0 to 2 risk factors the risk of relapse after 1 year was 15%.
• A patient who relapses usually can achieve remission if infliximab is restarted.
Specialty: Gastroenterology
