From the Guidelines
Infliximab treatment for CRMO should be continued for at least 12 months to achieve optimal clinical response and minimize the risk of disease relapse. The treatment regimen typically involves administering infliximab at a dose of 5 mg/kg intravenously at weeks 0,2, and 6, followed by maintenance dosing every 8 weeks, as supported by the guidelines for the treatment of psoriasis and psoriatic arthritis with biologics 1.
Key Considerations for Infliximab Treatment in CRMO
- Continuous treatment with infliximab is preferred over intermittent therapy to maintain clinical responses and reduce the development of antibodies against infliximab 1.
- The dose and frequency of infliximab administration may need to be adjusted based on individual patient response and tolerance.
- Close monitoring of clinical improvement, radiological findings, and inflammatory markers is essential to guide treatment decisions.
- Approximately 80% of patients achieve significant clinical response, such as PASI-75, at week 10, indicating the rapid efficacy of infliximab 1.
Treatment Outcomes and Disease Relapse
- Treatment continuation should be guided by clinical improvement and radiological findings showing resolution of bone inflammation.
- Once remission is achieved and maintained for 6-12 months, gradual dose tapering can be considered before complete discontinuation.
- However, it is crucial to note that approximately 30-40% of patients may experience disease relapse after stopping infliximab, necessitating retreatment.
- Infliximab's mechanism of action in CRMO involves blocking tumor necrosis factor-alpha (TNF-α), effectively reducing osteoclast activation and bone resorption while promoting healing of lesions.
From the Research
Infliximab Duration in CRMO
- The duration of infliximab treatment in Chronic Recurrent Multifocal Osteomyelitis (CRMO) is not explicitly stated in the provided studies, but we can look at the treatment duration in the individual case reports.
- In the study by 2, an 18-year-old girl with CRMO was treated with infliximab for 21 months, during which she experienced only one mild episode of recurrence.
- Another study by 3 reports a case of a 17-year-old man with CRMO who was treated with infliximab and achieved complete remission, but the duration of treatment is not specified.
Treatment Outcomes
- The studies suggest that infliximab can be an effective treatment option for CRMO, with significant improvement in symptoms and reduction in recurrence rates 2, 3.
- However, the optimal duration of infliximab treatment in CRMO is not well established and may vary depending on individual patient responses and disease severity.
Safety and Tolerability
- Infliximab has been shown to be generally safe and well-tolerated in patients with various inflammatory disorders, including CRMO 4.
- The study by 4 reports a low frequency of infusion reactions (1.5%) and suggests that good clinical practices, such as low infusion rates and pre-treatment with anti-histamine and prednisone, can help reduce the risk of adverse reactions.