Factors Associated with Durable Response to Infliximab in Crohnʼs Disease 5 Years and Beyond: A Multicenter International Cohort

BACKGROUND: Infliximab (IFX) has been used for over a decade worldwide. Less is known about the natural history of IFX use beyond a few years and which patients are more likely to sustain benefits. METHODS: Patients with Crohn's disease (CD) exposed to IFX from Massachusetts General Hospital, Boston, Saint-Antoine Hospital, Paris, and the Swiss IBD Cohort Study were identified through retrospective and prospective data collection, complemented by chart abstraction of electronic medical records. We compared long-term users of IFX (>5 yr of treatment, long-term users of infliximab [LTUI]), with non-LTUI patients to identify prognostic factors. RESULTS: We pooled data on 1014 patients with CD from 3 different databases, of whom 250 were defined as LTUI. The comparison group comprised 290 patients with CD who discontinued IFX: 48 primary nonresponses, 95 loss of responses, and 147 adverse events. Factors associated with LTUI were colonic involvements and an earlier age at the start of IFX. The prevalence of active smokers and obese patients differed markedly, but inversely, between American and European centers but did not impact outcome. The discontinuation rate was stable around 3% to 6%, each year from years 3 to 10. CONCLUSIONS: Young age at start of IFX and colonic CD are factors associated with a beneficial long-term use of IFX. After 5 years of IFX, there is still a 3% to 5% discontinuation rate annually. Several factors associated with a good initial response such as nonsmoker and shorter disease duration at IFX initiation do not seem associated with a longer term response.

Luxurious Merovingian Textiles Excavated from Burials in the Saint Denis Basilica, France, 6th-7th century

A new examination of the textile fragments found in the Merovingian burials in the basilica of Saint Denis, near Paris, has recently underscored the diversity of fabrics used to make garments in which members of the royal court were buried. Among them, some woolens of fine quality had been dyed with indigotin. The most astonishing fibre found belongs to a mixed textile (not skin) with beaver fibers and wool. Silks contained shellfish purple and in one case kermes? Two dyestuffs associated with royalty and privilege. Along with this was large number of gold threads, probably produced locally and that were used in tablet-woven borders or for embroideries. In addition, several figured silks, of oriental origin, testify to the importance of this "foreign" material and the taste for textiles woven with complex techniques and probably what had originally had beautiful designs. Although none of these designs have been preserved and many colors have been greatly damaged, the technical characteristics of the remnants indicate proveniences as far as Byzantium, Sassanid Persia and the Chinese court. Such precious textiles show the high social status and political power of the Merovingian court, a testament to their ability to access such luxurious and costly textiles through diplomacy and/or trade with other powerful empires. The examination of these rare textiles along with other fine silks and luxury objects from the same period found in France expand our view of the fundamental role of textiles in the political sphere of this early period of European history.