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Examining maintenance care following infliximab salvage therapy for acute severe ulcerative colitis
Data supporting the optimal maintenance drug therapy and strategy to monitor ongoing response following successful infliximab (IFX) induction, for acute severe ulcerative colitis (ASUC), are limited. We aimed to evaluate maintenance and monitoring strategies employed in patients post-IFX induction t...
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Published in: | Journal of gastroenterology and hepatology 2018-01, Vol.33 (1), p.226-231 |
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container_title | Journal of gastroenterology and hepatology |
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creator | Seah, Dean Choy, Matthew C Gorelik, Alexandra Connell, William R Sparrow, Miles P Van Langenberg, Daniel Hebbard, Geoffrey Moore, Gregory De Cruz, Peter |
description | Data supporting the optimal maintenance drug therapy and strategy to monitor ongoing response following successful infliximab (IFX) induction, for acute severe ulcerative colitis (ASUC), are limited. We aimed to evaluate maintenance and monitoring strategies employed in patients post-IFX induction therapy.
Patients in six Australian tertiary centers treated with IFX for steroid-refractory ASUC between April 2014 and May 2015 were identified via hospital IBD and pharmacy databases. Patients were followed up for 1 year with clinical data over 12 months recorded. Analysis was limited to patient outcomes beyond 3 months.
Forty one patients were identified. Five of the 41 (12%) patients underwent colectomy within 3 months, and one patient was lost to follow-up. Six of 35 (17%) of the remaining patients progressed to colectomy by 12 months. Maintenance therapy: Patients maintained on thiopurine monotherapy (14/35) versus IFX/thiopurine therapy (15/35) were followed up. Two of 15 (13%) patients who received combination maintenance therapy underwent a colectomy at 12 months, compared with 1/14 (7%) patients receiving thiopurine monotherapy (P = 0.610). Monitoring during maintenance: Post-discharge, thiopurine metabolites were monitored in 15/27 (56%); fecal calprotectin in 11/32 (34%); and serum IFX levels in 4/20 (20%). Twenty of 32 (63%) patients had an endoscopic evaluation after IFX salvage with median time to first endoscopy of 109 days (interquartile range 113-230).
Following IFX induction therapy for ASUC, the uptake of maintenance therapy in this cohort and strategies to monitor ongoing response were variable. These data suggest that the optimal maintenance and monitoring strategy post-IFX salvage therapy remains to be defined. |
doi_str_mv | 10.1111/jgh.13850 |
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Patients in six Australian tertiary centers treated with IFX for steroid-refractory ASUC between April 2014 and May 2015 were identified via hospital IBD and pharmacy databases. Patients were followed up for 1 year with clinical data over 12 months recorded. Analysis was limited to patient outcomes beyond 3 months.
Forty one patients were identified. Five of the 41 (12%) patients underwent colectomy within 3 months, and one patient was lost to follow-up. Six of 35 (17%) of the remaining patients progressed to colectomy by 12 months. Maintenance therapy: Patients maintained on thiopurine monotherapy (14/35) versus IFX/thiopurine therapy (15/35) were followed up. Two of 15 (13%) patients who received combination maintenance therapy underwent a colectomy at 12 months, compared with 1/14 (7%) patients receiving thiopurine monotherapy (P = 0.610). Monitoring during maintenance: Post-discharge, thiopurine metabolites were monitored in 15/27 (56%); fecal calprotectin in 11/32 (34%); and serum IFX levels in 4/20 (20%). Twenty of 32 (63%) patients had an endoscopic evaluation after IFX salvage with median time to first endoscopy of 109 days (interquartile range 113-230).
Following IFX induction therapy for ASUC, the uptake of maintenance therapy in this cohort and strategies to monitor ongoing response were variable. These data suggest that the optimal maintenance and monitoring strategy post-IFX salvage therapy remains to be defined.</description><identifier>ISSN: 0815-9319</identifier><identifier>EISSN: 1440-1746</identifier><identifier>DOI: 10.1111/jgh.13850</identifier><identifier>PMID: 28618062</identifier><language>eng</language><publisher>Australia: Wiley Subscription Services, Inc</publisher><subject>Endoscopy ; Immunotherapy ; Induction therapy ; Inflammatory bowel disease ; Infliximab ; Metabolites ; Monoclonal antibodies ; Patients ; Tumor necrosis factor-α ; Ulcerative colitis</subject><ispartof>Journal of gastroenterology and hepatology, 2018-01, Vol.33 (1), p.226-231</ispartof><rights>2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.</rights><rights>2018 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c348t-7074070b5a20166ad236c194088ff48bea059d691845015ef8aaa078e95a20613</citedby><cites>FETCH-LOGICAL-c348t-7074070b5a20166ad236c194088ff48bea059d691845015ef8aaa078e95a20613</cites><orcidid>0000-0001-5206-0097 ; 0000-0003-3662-6307</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28618062$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Seah, Dean</creatorcontrib><creatorcontrib>Choy, Matthew C</creatorcontrib><creatorcontrib>Gorelik, Alexandra</creatorcontrib><creatorcontrib>Connell, William R</creatorcontrib><creatorcontrib>Sparrow, Miles P</creatorcontrib><creatorcontrib>Van Langenberg, Daniel</creatorcontrib><creatorcontrib>Hebbard, Geoffrey</creatorcontrib><creatorcontrib>Moore, Gregory</creatorcontrib><creatorcontrib>De Cruz, Peter</creatorcontrib><title>Examining maintenance care following infliximab salvage therapy for acute severe ulcerative colitis</title><title>Journal of gastroenterology and hepatology</title><addtitle>J Gastroenterol Hepatol</addtitle><description>Data supporting the optimal maintenance drug therapy and strategy to monitor ongoing response following successful infliximab (IFX) induction, for acute severe ulcerative colitis (ASUC), are limited. We aimed to evaluate maintenance and monitoring strategies employed in patients post-IFX induction therapy.
Patients in six Australian tertiary centers treated with IFX for steroid-refractory ASUC between April 2014 and May 2015 were identified via hospital IBD and pharmacy databases. Patients were followed up for 1 year with clinical data over 12 months recorded. Analysis was limited to patient outcomes beyond 3 months.
Forty one patients were identified. Five of the 41 (12%) patients underwent colectomy within 3 months, and one patient was lost to follow-up. Six of 35 (17%) of the remaining patients progressed to colectomy by 12 months. Maintenance therapy: Patients maintained on thiopurine monotherapy (14/35) versus IFX/thiopurine therapy (15/35) were followed up. Two of 15 (13%) patients who received combination maintenance therapy underwent a colectomy at 12 months, compared with 1/14 (7%) patients receiving thiopurine monotherapy (P = 0.610). Monitoring during maintenance: Post-discharge, thiopurine metabolites were monitored in 15/27 (56%); fecal calprotectin in 11/32 (34%); and serum IFX levels in 4/20 (20%). Twenty of 32 (63%) patients had an endoscopic evaluation after IFX salvage with median time to first endoscopy of 109 days (interquartile range 113-230).
Following IFX induction therapy for ASUC, the uptake of maintenance therapy in this cohort and strategies to monitor ongoing response were variable. These data suggest that the optimal maintenance and monitoring strategy post-IFX salvage therapy remains to be defined.</description><subject>Endoscopy</subject><subject>Immunotherapy</subject><subject>Induction therapy</subject><subject>Inflammatory bowel disease</subject><subject>Infliximab</subject><subject>Metabolites</subject><subject>Monoclonal antibodies</subject><subject>Patients</subject><subject>Tumor necrosis factor-α</subject><subject>Ulcerative colitis</subject><issn>0815-9319</issn><issn>1440-1746</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNpdkMFO3DAQhi1UxG6BQ1-gitQLHAIziePYxwoBrYTEBc7RxDtZvHKSrZ1s4e3rhW0Pncsc5vt_jT4hviBcYZrrzfrlCktdwZFYopSQYy3VJ7EEjVVuSjQL8TnGDQBIqKsTsSi0Qg2qWAp7-0q9G9ywznpyw8QDDZYzS4GzbvR-_L0_uaHz7tX11GaR_I7WnE0vHGj7lqCQkZ0nziLvOKVmb9NlcrvUMno3uXgmjjvykc8P-1Q8390-3fzIHx7vf958f8htKfWU11Cn96CtqABUilZFqSwaCVp3ndQtE1RmpQxqWQFW3Gkiglqz2ScUlqfi4qN3G8ZfM8ep6V207D0NPM6xQYNQG1mCSei3_9DNOIchfZcojSUUlSoSdflB2TDGGLhrtiFJCG8NQrM33yTzzbv5xH49NM5tz6t_5F_V5R_nGX30</recordid><startdate>201801</startdate><enddate>201801</enddate><creator>Seah, Dean</creator><creator>Choy, Matthew C</creator><creator>Gorelik, Alexandra</creator><creator>Connell, William R</creator><creator>Sparrow, Miles P</creator><creator>Van Langenberg, Daniel</creator><creator>Hebbard, Geoffrey</creator><creator>Moore, Gregory</creator><creator>De Cruz, Peter</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5206-0097</orcidid><orcidid>https://orcid.org/0000-0003-3662-6307</orcidid></search><sort><creationdate>201801</creationdate><title>Examining maintenance care following infliximab salvage therapy for acute severe ulcerative colitis</title><author>Seah, Dean ; Choy, Matthew C ; Gorelik, Alexandra ; Connell, William R ; Sparrow, Miles P ; Van Langenberg, Daniel ; Hebbard, Geoffrey ; Moore, Gregory ; De Cruz, Peter</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c348t-7074070b5a20166ad236c194088ff48bea059d691845015ef8aaa078e95a20613</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Endoscopy</topic><topic>Immunotherapy</topic><topic>Induction therapy</topic><topic>Inflammatory bowel disease</topic><topic>Infliximab</topic><topic>Metabolites</topic><topic>Monoclonal antibodies</topic><topic>Patients</topic><topic>Tumor necrosis factor-α</topic><topic>Ulcerative colitis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Seah, Dean</creatorcontrib><creatorcontrib>Choy, Matthew C</creatorcontrib><creatorcontrib>Gorelik, Alexandra</creatorcontrib><creatorcontrib>Connell, William R</creatorcontrib><creatorcontrib>Sparrow, Miles P</creatorcontrib><creatorcontrib>Van Langenberg, Daniel</creatorcontrib><creatorcontrib>Hebbard, Geoffrey</creatorcontrib><creatorcontrib>Moore, Gregory</creatorcontrib><creatorcontrib>De Cruz, Peter</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastroenterology and hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Seah, Dean</au><au>Choy, Matthew C</au><au>Gorelik, Alexandra</au><au>Connell, William R</au><au>Sparrow, Miles P</au><au>Van Langenberg, Daniel</au><au>Hebbard, Geoffrey</au><au>Moore, Gregory</au><au>De Cruz, Peter</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Examining maintenance care following infliximab salvage therapy for acute severe ulcerative colitis</atitle><jtitle>Journal of gastroenterology and hepatology</jtitle><addtitle>J Gastroenterol Hepatol</addtitle><date>2018-01</date><risdate>2018</risdate><volume>33</volume><issue>1</issue><spage>226</spage><epage>231</epage><pages>226-231</pages><issn>0815-9319</issn><eissn>1440-1746</eissn><abstract>Data supporting the optimal maintenance drug therapy and strategy to monitor ongoing response following successful infliximab (IFX) induction, for acute severe ulcerative colitis (ASUC), are limited. We aimed to evaluate maintenance and monitoring strategies employed in patients post-IFX induction therapy.
Patients in six Australian tertiary centers treated with IFX for steroid-refractory ASUC between April 2014 and May 2015 were identified via hospital IBD and pharmacy databases. Patients were followed up for 1 year with clinical data over 12 months recorded. Analysis was limited to patient outcomes beyond 3 months.
Forty one patients were identified. Five of the 41 (12%) patients underwent colectomy within 3 months, and one patient was lost to follow-up. Six of 35 (17%) of the remaining patients progressed to colectomy by 12 months. Maintenance therapy: Patients maintained on thiopurine monotherapy (14/35) versus IFX/thiopurine therapy (15/35) were followed up. Two of 15 (13%) patients who received combination maintenance therapy underwent a colectomy at 12 months, compared with 1/14 (7%) patients receiving thiopurine monotherapy (P = 0.610). Monitoring during maintenance: Post-discharge, thiopurine metabolites were monitored in 15/27 (56%); fecal calprotectin in 11/32 (34%); and serum IFX levels in 4/20 (20%). Twenty of 32 (63%) patients had an endoscopic evaluation after IFX salvage with median time to first endoscopy of 109 days (interquartile range 113-230).
Following IFX induction therapy for ASUC, the uptake of maintenance therapy in this cohort and strategies to monitor ongoing response were variable. These data suggest that the optimal maintenance and monitoring strategy post-IFX salvage therapy remains to be defined.</abstract><cop>Australia</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28618062</pmid><doi>10.1111/jgh.13850</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0001-5206-0097</orcidid><orcidid>https://orcid.org/0000-0003-3662-6307</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Endoscopy Immunotherapy Induction therapy Inflammatory bowel disease Infliximab Metabolites Monoclonal antibodies Patients Tumor necrosis factor-α Ulcerative colitis |
title | Examining maintenance care following infliximab salvage therapy for acute severe ulcerative colitis |
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