Infliximab for treatment of steroid-refractory ulcerative colitis

• Published in: Digestive and liver disease 2002-09, Vol.34 (9), p.631-634
• Main Authors: Actis, G.C., Bruno, M., Pinna-Pintor, M., Rossini, F.P., Rizzetto, M.
• Format: Article
• Language: English
• Subjects: Adult; Antibodies, Monoclonal - therapeutic use; C-Reactive Protein - analysis; Colitis, Ulcerative - classification; Colitis, Ulcerative - drug therapy; Female; Gastrointestinal Agents - therapeutic use; Humans; immunosuppressive treatments; inflammatory bowel disease; Infliximab; Male; Middle Aged; Severity of Illness Index; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors; ulcerative colitis
• ISSN: 1590-8658; 1878-3562
• DOI: 10.1016/S1590-8658(02)80205-5

Background. Success achieved in two subtypes of Crohn's disease has persuaded a few investigators to experiment the monoclonal anti-tumour necrosis factor antibody infliximab in the treatment of ulcerative colitis. So far, however, the results (achieved in some 30 steroid-refractory patients included in two independent full-papers) indicate a rate of initial response of 50% and of remission of 25%. Aims. To analyse data of an open trial conducted on consecutive steroid-refractory severely ill patients admitted to our referral Unit. Patients and Methods. In 9 months, infliximab was given to 8 patients (4 male, 4 female aged 20–60 years) with uncontrolled ulcerative colitis of whom 6 were non-responders to parenteral steroids. All received the first infliximab dose as an intravenous infusion of 5 mg/kg Results. Of the 8, 4 (50%) did not respond to the first injection and were submitted to urgent colectomy; the other four responded clinically. Two have maintained clinical remission for 7 months, without the need for steroids; both have received daily azathioprine at 2 mg/kg, and only one has received two further infliximab injections. Of the other two, one received a second injection at week 5, despite this relapsed, and underwent elective colectomy at that time; the other relapsed at 6 months and showed a partial response to a repeat infliximab infusion. Thus, the rate of sustained response is 2 8 (25%) in this study. Conclusion. These results, achieved in an open uncontrolled fashion, seem to reflect those of other independent studies. In our opinion, these findings warrant an in-depth reappraisal of the indication to use infliximab as rescue treatment for refractory ulcerative colitis.