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Journal of Crohn's and Colitis: 9 (4)

Editor-in-Chief

Laurence J. Egan, Ireland

Associate Editors

Maria T. Abreu, USAShomron Ben-Horin, IsraelSilvio Danese, ItalyPeter Lakatos, HungaryMiles Parkes, UKGijs van den Brink, NLSéverine Vermeire, Belgium

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Long-term outcome after infliximab for refractory ulcerative colitis

Marc Ferrante , Séverine Vermeire , Herma Fidder , Fabian Schnitzler , Maja Noman , Gert Van Assche , Gert De Hertogh , Ilse Hoffman , Andre D'Hoore , Kristel Van Steen , Karel Geboes , Freddy Penninckx , Paul Rutgeerts
DOI: http://dx.doi.org/10.1016/j.crohns.2008.03.004 219-225 First published online: 1 September 2008

Abstract

Background and aims: Infliximab (IFX) has been shown efficacious for moderate-to-severe ulcerative colitis (UC), but data on long-term efficacy are lacking. We investigated long-term outcome including colectomy rates in outpatients treated with IFX for refractory UC in a single referral centre, and evaluated if predictors could be identified.

Methods: The first 121 outpatients (median age 38.0 years) with refractory UC treated with IFX were included. The primary outcome was colectomy-free survival. Secondary measures were sustained clinical response and serious adverse events.

Results: From the 81 patients (67%) with an initial clinical response to IFX, 68% had a sustained clinical response. No independent predictors of sustained clinical response could be identified. Over a median (IQR) follow-up period of 33.0 (17.0–49.8) months, 21 patients (17%) came to colectomy. Independent predictors of colectomy were absence of short-term clinical response [Hazard ratio 10.8 (95% CI 3.5–32.8), p < 0.001], a baseline CRP level ≥ 5 mg/L [Hazard ratio 14.5 (95% CI 2.0–108.6), p = 0.006] and previous IV treatment with corticosteroids and/or cyclosporine [Hazard ratio 2.4 (95% CI 1.1–5.9), p = 0.033]. Six patients developed a serious infection, three a malignancy, two a post-operative complication and one patient died (suicide).

Conclusions: With a median follow-up of 33.0 months after start of IFX, 17% of patients with refractory UC needed colectomy, while sustained clinical response was present in 68% of initial responders.

Keywords
  • Inflammatory bowel disease
  • Ulcerative colitis
  • Infliximab
  • Anti-TNF
  • Outcome
  • Colectomy
  • Predictor
  • Abbreviations
    ACT
    active ulcerative colitis trial
    CI
    confidence interval
    IFX
    infliximab
    IQR
    interquartile range
    IV
    intravenous
    MDR1
    multidrug resistance gene 1
    PCR
    polymerase chain reaction
    RFLP
    restriction fragment length polymorphism
    UC
    ulcerative colitis.
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