Twenty years of biological therapy in an patient with IBD.

This interesting case is the first to our knowledge to report outcomes of a patient with Crohn's disease (CD) treated with the biological drug, infliximab, for around 20 years. The case highlights the positive effect of long-term use of infliximab in achieving and maintaining remission in a patient with CD.In this case, loss of response to infliximab was not dependent on length of exposure to the drug. It also appeared that infliximab was still efficacious after drug holidays, which can be especially important around times of pregnancy. Of interest, 'loss of response' to infliximab occurred at one particular time point. The drug was then reintroduced at a later date, which gave the patient clinical benefit. This case suggests that in some situations infliximab can be reintroduced in patients with previous 'loss of response'.Importantly, in this case, Infliximab had no major adverse effects during the 20 years follow-up. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.