Long-Term Follow-Up of Patients Treated with Infliximab for Ulcerative Colitis: Predictive Factors of Response—An Observational Study

García-Bosch, Orlando; Aceituno, Montserrat; Ordás, Íngrid; Etchevers, J.; Sans, Miquel; Feu, Faust; Panés, Julián; Ricart, Elena

doi:10.1007/s10620-016-4089-2

Cited by 16 publications

(7 citation statements)

References 21 publications

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“…Albumin concentrations can also reflect systemic inflammatory burden, nutritional status, and poor prognosis in multiple disease entities. Hypoalbuminemia is associated with infliximab failure in adult UC [ 17 – 19 ], whereas higher concentrations of albumin predicts remission 8 weeks after infliximab induction [ 20 ]. Together, low albumin and high CRP concentrations are linked with disease severity [ 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

C-Reactive Protein/Albumin Ratio at Diagnosis of Pediatric Inflammatory Bowel Disease: A Retrospective Multi-Center Study

et al. 2022

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Background This study aimed to evaluate the C-reactive protein-to-albumin (CRP/albumin) ratio at diagnosis of pediatric inflammatory bowel disease (IBD). Material/Methods Serum CRP/albumin ratio was calculated for patients with Crohn’s disease (CD; n=186) and ulcerative colitis (UC; n=159) aged 3–18 years. Results Patients with CD differed in CRP/albumin ratio at diagnosis in groups with quiescent, mild, moderate, and severe disease ( P =0.011). CRP/albumin ratio at diagnosis was significant in differentiating patients with severe CD from quiescent disease at diagnosis (area under the curve (AUC)=0.94, odds ratio (OR)=63.4, 95% confidence interval (CI) 7.1–569.1, P <0.0001). CRP/albumin ratio at diagnosis could moderately differentiate penetrating from non-penetrating disease behavior in CD at diagnosis (AUC=0.73, OR=6.3, 95% CI 2.0–19.3, P <0.001). Furthermore, CRP/albumin ratio at diagnosis weakly differentiated IBD patients in need of biological treatment in a step-up procedure (AUC=0.58, OR=2.1, 95% CI 1.3–3.4, P =0.022) and in need of surgery (AUC=0.63, OR=3.1, 95% CI 1.4–7.2, P =0.006). For the IBD, CRP/albumin ratio at diagnosis was weakly correlated with age at first immunosuppressive treatment (rho=0.20, P =0.018), time from diagnosis to first biological treatment (rho=−0.37, P <0.001), days spent in hospital (rho=0.26, P =0.007), number of severe relapses (rho=0.31, P =0.001), and Pediatric Crohn’s Disease Activity Index (rho=0.38, P =0.002). Conclusions The present findings add to previous studies carried out in adult patients and show that the CRP/albumin ratio at diagnosis was not significantly associated with the course of either CD or UC in children. However, CRP/albumin ratio could differentiate patients with severe CD from those with quiescent disease.

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Section: Introductionmentioning

confidence: 99%

C-Reactive Protein/Albumin Ratio at Diagnosis of Pediatric Inflammatory Bowel Disease: A Retrospective Multi-Center Study

et al. 2022

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“…As clinical outcomes may differ, it is important to acquire real‐world data from patients not being treated within study conditions of randomised controlled trials. Long‐term outcome studies of anti‐TNF therapy with an observation time longer than 5 years are limited and showed average treatment persistence rates from 2.1 to 7.3 years 11‐16 …”

Section: Introductionmentioning

confidence: 99%

“…Long‐term outcome studies of anti‐TNF therapy with an observation time longer than 5 years are limited and showed average treatment persistence rates from 2.1 to 7.3 years. 11 , 12 , 13 , 14 , 15 , 16 …”

Section: Introductionmentioning

confidence: 99%

Limited long‐term treatment persistence of first anti‐TNF therapy in 538 patients with inflammatory bowel diseases: a 20‐year real‐world study

Blesl

Binder

Högenauer

et al. 2021

Aliment Pharmacol Ther

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Summary Background Anti‐TNF antibodies were the first biologic treatment option for patients with inflammatory bowel diseases. Aims To assess length of treatment persistence of first anti‐TNF therapy and influencing factors used in the standard care of patients with inflammatory bowel diseases. Methods Single‐centre, retrospective study from a register including patients who received anti‐TNF therapy in the last 20 years at the study centre. Kaplan‐Meier analysis with log‐rank test was used to describe treatment persistence. With multivariable Cox regression analysis, risk factors for treatment failure were investigated. Results Five hundred thirty‐eight patients (CD, Crohn's disease: 367, UC, ulcerative colitis: 147, inflammatory bowel disease unclassified: 24) with a median follow‐up of 8.1 years were included. Median (95% confidence interval) treatment persistence in the total cohort was 2.3 years (28 [22, 38] months), and nearly half of patients withdrew from treatment within 2 years. Male patients were treated longer than females (male: 37 [25, 48] months, female: 23 [14, 33] months, P = 0.002). Treatment persistence was longer in CD compared to UC (CD: 39 [30, 50] months, UC: 13 [9, 19] months, P < 0.001), and patients with CD remained longer on adalimumab than on infliximab treatment (adalimumab: 67 [55, 95] months, infliximab: 19 [14, 31] months, P < 0.001). Treatment failure (52%) and side effects (25%) were the most common reasons for withdrawal from therapy; 14% withdrew due to remission. Female sex was identified as independent predictor for treatment failure in UC (hazard ratio [CI]: 1.73 [1.02‐2.92], P = 0.04). Conclusion Long‐term treatment persistence of first anti‐TNF therapy was limited in patients with inflammatory bowel diseases, primarily due to treatment failure and side effects.

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“…These studies provided data on LOR incidence (n = 38), 11 , 23–59 and/or dose escalation incidence (n = 31), 11 , 24 , 26–28 , 31 , 33 , 37–41 , 47–50 , 53–57 , 59–68 and/or dose escalation outcomes (n = 15). 11 , 12 , 27 , 31 , 39 , 50 , 53–56 , 59 , 62 , 66 , 69 , 70 Outcomes for IFX were described in 34 studies. 12 , 23–39 , 49–52 , 56 , 57 , 59–66 , 69 , 70 Outcomes for ADA were described in 23 studies.…”

Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-analysis: Loss of Response and Need for Dose Escalation of Infliximab and Adalimumab in Ulcerative Colitis

Savelkoul

Thomas

Derikx

et al. 2022

Inflammatory Bowel Diseases

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Background Loss of response to infliximab or adalimumab in ulcerative colitis occurs frequently, and dose escalation may aid in regaining clinical benefit. This study aimed to systematically assess the annual loss of response and dose escalation rates for infliximab and adalimumab in ulcerative colitis. Methods A systematic search was conducted from August 1999 to July 2021 for studies reporting loss of response and dose escalation during infliximab and/or adalimumab use in ulcerative colitis patients with primary response. Annual loss of response, dose escalation rates, and clinical benefit after dose escalation were calculated. Subgroup analyses were performed for studies with 1-year follow-up or less. Results We included 50 unique studies assessing loss of response (infliximab, n = 24; adalimumab, n = 21) or dose escalation (infliximab, n = 21; adalimumab, n = 16). The pooled annual loss of response for infliximab was 10.1% (95% confidence interval [CI], 7.1-14.3) and 13.6% (95% CI, 9.3-19.9) for studies with 1-year follow-up. The pooled annual loss of response for adalimumab was 13.4% (95% CI, 8.2-21.8) and 23.3% (95% CI, 15.4-35.1) for studies with 1-year follow-up. Annual pooled dose escalation rates were 13.8% (95% CI, 8.7-21.7) for infliximab and 21.3% (95% CI, 14.4-31.3) for adalimumab, regaining clinical benefit in 72.4% and 52.3%, respectively. Conclusions Annual loss of response was 10% for infliximab and 13% for adalimumab, with higher rates during the first year. Annual dose escalation rates were 14% (infliximab) and 21% (adalimumab), with clinical benefit in 72% and 52%, respectively. Uniform definitions are needed to facilitate more robust evaluations.

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Long-Term Follow-Up of Patients Treated with Infliximab for Ulcerative Colitis: Predictive Factors of Response—An Observational Study

Abstract: Low albumin, previous treatment with cyclosporine, absence of a concomitant immunomodulator, and lack of response at week 8 negatively affected the efficacy of infliximab in ulcerative colitis.

Cited by 16 publications

References 21 publications

C-Reactive Protein/Albumin Ratio at Diagnosis of Pediatric Inflammatory Bowel Disease: A Retrospective Multi-Center Study

C-Reactive Protein/Albumin Ratio at Diagnosis of Pediatric Inflammatory Bowel Disease: A Retrospective Multi-Center Study

Limited long‐term treatment persistence of first anti‐TNF therapy in 538 patients with inflammatory bowel diseases: a 20‐year real‐world study

Systematic Review and Meta-analysis: Loss of Response and Need for Dose Escalation of Infliximab and Adalimumab in Ulcerative Colitis

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