Efficacy Of Infliximab In The Treatment Of Inflammatory Bowel Disease

BackgroundInflammatory Bowel Disease(IBD)is a chronic non-specific gastrointestinal inflammatory disease,characterized by episode and remission of appear alternately.Its pathogenesis is unclear,which is generally accepted that the onset and progress is due to genetic factors,environmental factors,infection joint action of autoimmune aspects.IBD mainly comprises two clinical subtypes,including Ulcerative Colitis(UC)and Crohn Disease(CD).The incidence and prevalence of IBD are increasing in China,and it has become one of the most common diseases of digestive system.The treatment for IBD is based on stratified medication to assess the severity of the patient’s disease.With the emergence of biological agents such as infliximab,a new treatment path has been indicated for patients.Despite its efficacy,retrospective studies have shown that 30 to 60 percent of patients with UC ultimately fail treatment with anti-tumor necrosis factor drugs.8-10%of patients with UC have 22%to 30%primary nonresponse(PNR).Up to 33.7%of induction therapy responders experience secondary unresponsiveness within the first year of treatment initiation.Follow-up of IBD depends on a combination of endoscopy and serological indicators.Since the serological indicators can change with the progression of the disease and the time when drugs plays their role,it can be considered to use the early changes of theses indicators to predict the long-term effects of medication,so as to facilitate early and timely dose enhancement or adjustment of treatment regimens and reduce the risk of treatment failure for patients.ObjectiveClinical data of patients with inflammatory bowel disease who were treated with infliximab in our hospital from January 2015 to December 2019 were collected to investigate the therapeutic effect of infliximab and its comparison with the efficacy of traditional immunosuppressant,and to preliminarily analyze the correlation between the changes of early serological indicators and the efficacy of IFX.MethodsSixty-five patients with IBD who received regular infliximab treatment in the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2019 were selected.Induction therapy with IFX5mg/kg was given at week 0,2,and 6,followed by maintenance therapy at the same dose every 8 weeks.132 patients with moderate to severe active IBD who received regular immunosuppressant treatment in our hospital during the same period were selected.The general information and clinical symptoms of the patients were recorded.(1)The improvement of clinical symptoms at 0,2,14 and 30 weeks after IFX treatment was recorded;(2)Comparison of laboratory examination results at 0,2,14,and 30 weeks after IFX treatment,including WBC,HGB,PLT,ESR,CRP,and ALB;(3)Changes in clinical scores after 0 and 30 weeks of IFX treatment were recorded:Modified Mayo score was used for patients with UC,and CDAI score and SES-CD endoscopic score were used for patients with CD.(4)Comparison of the effective rates of IFX and immunosuppressant treatment at 14 and 30 weeks after treatment;(5)The correlation between the W0/W2 ratio and the curative effect in IFX group;(6)IFX adverse reactions;(7)SPSS 22.0 software was used to analyze the data,and P<0.05 was considered statistically significant.Results1.There were 197 patients with IBD in this study,including 65 patients in the IFX group,including 12 males and 14 females in the UC group,with an average age of 38.72±15.99 years and a median course of disease of 2 years;27 males and 12 females in the CD group,with an average age of 33.23±14.04 years and a median course of disease of 3 years.In the immunosuppressant group,there were 132 patients,including 43 males and 29 females in the UC group,with a mean age of 40.23±16.03 years and a median course of disease of 3 years;in the CD group,there were 42 males and 18 females,with a mean age of 35.45±11.33 years and a median course of disease of 4.5 years.2.After IFX treatment for 30 weeks,abdominal pain,diarrhea,hematochezia and fever were all relieved to a certain extent among which abdominal pain(P=0.000)and hematochezia(P=0.001)were statistically different in the UC group before and after treatment,and abdominal pain(P=0.000),diarrhea(P=0.000)and hematochezia(P=0.006)were statistically different in the CD group before and after treatment.3 patients with paranormal arthritis were well controlled after medication,and 2 patients with recurrent oral and/or vulvar ulcers were reduced in frequency and area of recurrence.2 patients with perianal abscess were cured in 14 weeks,and 2 patients developed chronic perianal abscess.5 patients with fistula were closed to varying degrees after treatment.2 patients underwent surgical treatment.3.The WBC,PLT,HBG,CRP,ESR and ALB of the patients tended to be normal after IFX treatment for 30 weeks.In UC group,WBC(P=0.000),ESR(P=0.000)and CRP(P=0.000)were lower than before,while HBG(P=0.043)and ALB(P=0.016)were higher than before.WBC(P=0.025),PLT(P=0.012)and CRP(P=0.000)in CD group were lower than before,while HBG(P=0.033)and ALB(P=0.000)were higher than before.4.After 30 weeks of IFX treatment,the Mayo score in the UC group decreased from 10.97±0.63 to 3.24±0.79(t=17.74 P=0.000).The CDAI score in CD group decreased from 247.23±19.37 to 86.45±7.88(t=20.035 P=0.000).The endoscopic SES-CD score decreased from 9.68±3.37 to 3.21±2.06(t=32.167 P=0.000).5.After 14 weeks of treatment,55 cases(84.62%)were effective in IFX treatment,which was higher than 76 cases(57.58%)in the immunosuppressant control group(P=0.000).At 30 weeks of treatment,58 patients(93.85%)were effective in IFX treatment,which was higher than 92 patients(69.70%)in immunosuppressant control group(P=0.024).6.The W0/W2 ratio of each serological index was calculated to compare the differences in different therapeutic groups.The W0/W2 ratio of WBC(P=0.017),CRP(P=0.010)and ALB(P=0.000)was correlated with therapeutic effect.7.During IFX treatment,a total of 8 patients developed allergic reactions of varying degrees,including rash,head and face flashes,and shortness of breath.The symptoms were quickly corrected after the use of antiallergic drugs,and similar symptoms did not appear after the use of the antiallergic drugs again.One patient developed fever due to upper respiratory tract infection.Suspicious tuberculosis occurred in 1 patient after medication,and he was sent to the respiratory department for further treatment.No malignant tumor was observed during medication.No serious adverse reactions were observed.The incidence of adverse reactions was 15.38%.Conclusion1.Infliximab is effective in the treatment of moderate to severe inflammatory bowel disease2.The efficacy of infliximab in the treatment of inflammatory bowel disease is better than that of traditional immunosuppressants.And infliximab takes effect quickly.So early accelerated application of infliximab should be considered3.The trend of early WBC,CRP and ALB was correlated with the treatment effect of infliximab4.The incidence of adverse reactions of infliximab is low and the safety is high...