Objective: To assess the impact of maintenance versus episodic infliximab therapy on hospitalizations and surgery in patients with Crohn's disease (CD).
Methods: A retrospective analysis of claims data was conducted from the Marketscan Commercial Claims and Encounters database from 2000 to 2003 for claimants with CD (ICD-9 codes, 555.0, 555.1, 555.2 or 555.9) who had an induction regimen (3 infusions) of infliximab in 2003. Continuous enrollment for 12 months pre and 12 months post the index infusion date in 2003 was required. Patients were excluded if they had infliximab infusions in 2001 or 2002. Cohort analyses were conducted for three distinct cohorts: 1) 1–2 infliximab infusions; 2) 3–4 infliximab infusions; 3) 5 or more infliximab infusions.
Results: Analyses were conducted on 126 patients who met the inclusion criteria. The majority of patients were female (53.2%) and the mean age was 49.5 years. Among the cohort with 5 or more infliximab infusions (n=34); 20.6% required hospitalization, as compared to 37.5% of the cohort with 1–2 infusions (n=48) and 34.1% of the cohort with 3–4 infusions (n=44). The cohort with 5 or more infliximab infusions also had fewer mean hospitalizations (1.29 vs. 1.83 and 1.47, ns), and shorter lengths of stay (5.11 days vs. 5.64 days and 5.91 days, ns). In addition, the percentage of patients requiring surgery was decreased for the 5 or more infusion cohort (24%) as compared to the other cohorts (40% each).
Conclusions: Although non-significant, the results of this analysis indicate that when treating CD with a maintenance schedule of infliximab, the number and length of hospitalizations are reduced, and the percentage of patients requiring surgery decreases. Infliximab should be used on a maintenance schedule rather than episodically (ie: treat flares) in order to optimize treatment outcomes.
