Infliximab in severe ulcerative colitis: short‐term results of different infusion regimens and long‐term follow‐up

• Published in: Alimentary Pharmacology and Therapeutics 2007-09, Vol.26 (5), p.747-756
• Main Authors: KOHN, A., DAPERNO, M., ARMUZZI, A., CAPPELLO, M., BIANCONE, L., ORLANDO, A., VISCIDO, A., ANNESE, V., RIEGLER, G., MEUCCI, G., MARROLLO, M., SOSTEGNI, R., GASBARRINI, A., PERALTA, S., PRANTERA, C.
• Format: Article
• Language: English
• Subjects: Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal - adverse effects; Biological and medical sciences; Colitis, Ulcerative - drug therapy; Digestive system; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Agents - administration & dosage; Gastrointestinal Agents - adverse effects; Humans; Infliximab; Legionella pneumophila; Male; Medical sciences; Other diseases. Semiology; Pharmacology. Drug treatments; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Time Factors; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors
• ISSN: 0269-2813; 1365-2036; 0953-0673
• DOI: 10.1111/j.1365-2036.2007.03415.x

Summary Background Severe ulcerative colitis is a life‐threatening disorder, despite i.v. glucocorticoids treatment. Infliximab has been proposed as a safe rescue therapy. Aim To evaluate short‐ and long‐term effectiveness and safety of infliximab in severe refractory ulcerative colitis. Methods Eighty‐three patients with severe ulcerative colitis (i.v. glucocorticoids treatment‐refractory) were treated with infliximab in 10 Italian Gastroenterology Units. Patients underwent one or more infusions according to the choice of treating physicians. Short‐term outcome was colectomy/death 2 months after the first infusion. Long‐term outcome was survival free from colectomy. Safety data were recorded. Results Twelve patients (15%) underwent colectomy within 2 months. One died of Legionella pneumophila infection 12 days after infliximab. Early colectomy rates were higher in patients receiving one infusion (9/26), compared with those receiving two/more infusions (3/57, P = 0.001, OR = 9.53). Seventy patients who survived colectomy and did not experience any fatal complications were followed‐up for a median time of 23 months; 58 patients avoided colectomy during the follow‐up. Forty‐two patients were maintained on immunosuppressive drugs. No clinical features were associated with outcomes. Conclusions Infliximab is an effective and relatively safe therapy to avoid colectomy and maintain long‐term remission for patients with severe refractory ulcerative colitis. In the short term, two or more infusions seem to be more effective than one single infusion.