How do we use infliximab at Mount Sinai?

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How do we use infliximab at Mount Sinai?

• Lloyd Mayer M.D.
• Mount Sinai Medical Center

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Improvement in Clinical ResponseWith Infliximab


Response ()
10 mg/kg
5 mg/kg
20 mg/kg
Placebo
Treatment group
Targan SR et al. N Engl J Med. 19973371029-1035
.
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Fistula Healing With Infliximab
p lt 0.001. p lt 0.041.Complete response
defined as all fistulasclosed for 2 consecutive
visits (at least 1 month).
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Reduction in Corticosteroid Dose With Infliximab
Over Time
ACCENT I
Single dose
20
5 mg/kg q 8 wk
10 mg/kg q 8 wk
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Median Corticosteroid Dose
10
5
0
54
2
6
10
22
30
38
46
Weeks
Hanauer S et al. Lancet. 20023591541.
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SummaryInfliximab at Mount Sinai

• 2-dose regimen maximizes tolerance/efficacy
• Optimize dosing (5-20 mg/kg) for the patient
• Patients should be on immunomodulators
• Reduces ATIs
• Expect maintenance (reduces ATIs)
• Mean duration of response 8 Weeks (range 4-20)
• Infliximab may be a Bridge therapy
• Increase dose/shorten intereval for infusion
  reactions