Implications of infliximab treatment failure and influence of personalized treatment on patient-reported health-related quality of life and productivity outcomes in Crohn's disease

BACKGROUND: This study assessed implications of infliximab (IFX) treatment failure on patient-reported outcomes, and explored the influence of using personalized treatment in this situation.

METHODS: 69 Crohn's disease patients with IFX treatment failure were randomized to intensified IFX regimen (n=36), or personalized treatment defined by IFX and anti-IFX antibodies (n=33). Health related quality of life evaluated by Short Inflammatory Bowel Disease Questionnaire (IBDQ), and productivity evaluated by Work Productivity and Activity Impairment Questionnaire (WPAI:CD), were assessed at treatment failure and after 4, 8, 12, and 20 weeks.

RESULTS: IBDQ score at manifestation of IFX treatment failure was median 40, and improved markedly in responders by median 11 at weeks 4 and 8 (p<0.001), and 13 at weeks 12 and 20 (p<0.001). Non-responders improved modestly at weeks 12 and 20 (median 4, p<0.05). Overall activity impairment was high at IFX failure (median 70%), and decreased substantially in responders (40-50%, p<0.001), and to lesser extent in non-responders (15-40%, p<0.05). In employed patients (55%), absenteeism was negligible during the entire study period. However, presenteeism was median 40% at manifestation of IFX failure and decreased only among responders across time (median decrease 10-30%, p<0.05). Although anti-TNF therapy was discontinued in most patients handled by personalized treatment, IBDQ and WPAI:CD scores were similar in these patients as compared to patients routinely dose intensified on IFX.

CONCLUSION: Regaining low disease activity after IFX failure is necessary for minimizing patient impairment and indirect disease-related costs. A personalized treatment strategy does not have negative influence on patient-reported outcomes.