Clinical trial: colectomy after rescue therapy in ulcerative colitis – 3‐year follow‐up of the Swedish‐Danish controlled infliximab study

Gustavsson, Anders; Järnerot, Gunnar; Hertervig, Erik; Friis-Liby, Ingalill; Blomquist, Lars; Karlén, Per; Grännö, Christer; Vilien, M.; Ström, Magnus; Verbaan, Hans; Hellström, Per M.; Magnuson, Anders; Halfvarson, Jonas; Tysk, Curt

doi:10.1111/j.1365-2036.2010.04435.x

Cited by 167 publications

(131 citation statements)

References 32 publications

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“…In a randomised placebo-controlled trial, a single 5 mg/kg infusion reduced colectomy rate within 3 months by 40% compared to placebo. 8 Although the benefits of rescue therapy with IFX seem to remain in the subsequent 3-year follow-up, 9 few data are available concerning the efficacy in the long-term. Open label series with different length follow-up and different IFX dose regimens report an overall colectomy rate ranging from 18% to 75%.…”

Section: Introductionmentioning

confidence: 99%

Infliximab three-dose induction regimen in severe corticosteroid-refractory ulcerative colitis: Early and late outcome and predictors of colectomy

Monterubbianesi

Aratari

Armuzzi

et al. 2014

Journal of Crohn's and Colitis

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Section: Introductionmentioning

confidence: 99%

Infliximab three-dose induction regimen in severe corticosteroid-refractory ulcerative colitis: Early and late outcome and predictors of colectomy

Monterubbianesi

Aratari

Armuzzi

et al. 2014

Journal of Crohn's and Colitis

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“…A follow-up study showed that the results after 3 years remained in favor of IFX. 18 Following uncontrolled series have confirmed the efficacy of IFX in this group of patients. [19][20][21][22][23] There are currently no data comparing the efficacy of these two rescue therapies in steroid-refractory, severe attacks of UC.…”

mentioning

confidence: 77%

“…Colectomy-free survival in the Swedish-Danish trial after 3 years was 50% in IFX-treated patients and 24% in those given placebo (P ¼ 0.012). 18 The Active Ulcerative Colitis Trial (ACT)-1 and ACT-2 trials 29 included patients with chronic active UC. 30 Patients were randomized to receive IFX infusions, 5 or 10 mg/kg, at weeks 0, 2, and 6 and then every 8 weeks or placebo.…”

Section: Discussionmentioning

confidence: 99%

Infliximab or Cyclosporine as Rescue Therapy in Hospitalized Patients with Steroid-Refractory Ulcerative Colitis: A Retrospective Observational Study

Sjöberg

Walch

Meshkat

et al. 2012

Inflammatory Bowel Diseases

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“…Infliximab has been shown to reduce colectomy rates in patients with chronic refractory [47] or acute severe UC [48] for up to 3 years. However, a meta-analysis showed that overall colectomy rates are not reduced in the infliximab era [49] and consequently physicians must be able to manage post-colectomy complications that may arise.…”

Section: The Problematic Pouchmentioning

confidence: 99%

Managing Intractable Proctitis and the Problematic Pouch

Kent

Keshav²

2014

Dig Dis

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Proctitis accounts for a significant proportion of cases of ulcerative colitis (UC), and some patients subsequently develop more extensive disease. However, most patients continue to have limited inflammation, although the changes in the distal colon and rectum can occasionally be severe, and symptoms of increased frequency, rectal bleeding and urgency can be as disabling as they are for patients with more extensive colitis. Furthermore, although symptoms are typically well controlled with standard medications, medically refractory proctitis poses particular problems. Patients generally are not systemically unwell, and there is no added fear of cancer. Therefore, the prospect of colectomy for such limited disease is resisted by patients, physicians and surgeons alike. Unusual therapies, often delivered locally by enema or suppository, have been tested in small case series without definitive outcomes. The pathogenesis of such limited, yet intractable inflammation remains unclear, and the differential diagnosis should be carefully reviewed to ensure that local disease, whether it is infectious, vascular, or a result of injury or degeneration, is not overlooked. Ileo-anal pouch formation is the surgery of choice for about 20% of patients with UC who undergo colectomy. In the majority of cases, this surgery results in an acceptable quality of life and freedom from a stoma. However, in a sizeable minority of cases, pouch dysfunction can cause intractable problems. The causes of pouch dysfunction are varied and must all be considered carefully, particularly in refractory cases. Pouchitis is a common issue and is usually transient and easily treated. However, refractory and chronic pouchitis can be challenging. Ischaemia, injury, infection and Crohn's disease can all cause refractory pouch dysfunction. In a minority of cases, there appears to be no apparent organic pathology, and the presumptive diagnosis is that of a functional pouch disorder. Although it is much rarer, neoplastic changes in the pouch must also be considered, and the risk managed appropriately. The management of both intractable proctitis and the problematic pouch is made more challenging by the wide differential diagnosis that must be considered and by the paucity of high-quality clinical trials to support any one therapy. Key strategies to overcoming these limitations include methodical and systematic investigation and review, and a willingness to tailor therapy to the individual patient. Clinical trials of new treatments should be supported, and data from the experience with small cohorts of patients should be meticulously collected, critically analysed and widely disseminated.

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Clinical trial: colectomy after rescue therapy in ulcerative colitis – 3‐year follow‐up of the Swedish‐Danish controlled infliximab study

Abstract: SUMMARY BackgroundThe long-term efficacy of infliximab as rescue therapy in steroid-refractory ulcerative colitis is not well described.

Cited by 167 publications

References 32 publications

Infliximab three-dose induction regimen in severe corticosteroid-refractory ulcerative colitis: Early and late outcome and predictors of colectomy

Infliximab three-dose induction regimen in severe corticosteroid-refractory ulcerative colitis: Early and late outcome and predictors of colectomy

Infliximab or Cyclosporine as Rescue Therapy in Hospitalized Patients with Steroid-Refractory Ulcerative Colitis: A Retrospective Observational Study

Managing Intractable Proctitis and the Problematic Pouch

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