A technology assessment report 1 on infliximab in chronic active Crohn's disease resistant to conventional treatment was abstracted in the Health Technology Assessment Database 2. Only two smaller trials (n = 181) had been completed at the time of the review but results from the larger ACCENT trial (n = 573) were not yet available. A single dose of infliximab was associated with significant treatment benefit at week 4 (NNT = 3 for response defined as a >= 70-point reduction in Crohn's Disease Activity Index), with approximately 30% of patients achieving remission of their symptoms at this time (NNT = 4). Benefit was, however, short-lived with the majority of patients relapsing beyond week 12.
Only one trial evaluated the use of infliximab in fistulising Crohn's disease. A three-dose treatment course resulted in complete healing of perianal/abdominal fistulae for more than 21 days in 46% of patients treated with infliximab versus 13% treated with placebo (NNT = 4). Again, treatment benefit was short-lived, with a median duration of 3 months.
According to a Canadian cost-effectiveness analysis 3 abstracted in the database 4, the incremental costs per additional quality-adjusted life year exceed traditional benchmarks for cost per QALY (ICUR 181,201 Canadian dollars/QALY for a single-infusion of infliximab to ICUR 696,078 Canadian dollars/QALY for maintenance therapy for responders).
Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals).
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