Treatment of acute ulcerative colitis with infliximab, a retrospective study from three Danish hospitals

Abstract

Our results show a lasting benefit of infliximab rescue therapy in 61% of patients with acute, steroid-refractory ulcerative colitis, a low incidence of late colectomies, and low frequency of steroid use in patients who avoided colectomy. High levels of C-reactive protein on admittance and at the first infliximab infusion were associated with colectomy. Our study adds to the growing experience of infliximab treatment of patients with acute, steroid-refractory ulcerative colitis.

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

“…15 In the randomised controlled trial by Jarnerot et al, 8 the early colectomy rate after one single IFX infusion was 29%. Similar percentages have been reported in two recently published large observational retrospective studies from Denmark and Sweden, 22,23 in which a flexible IFX induction regimen was used (approximately 50% of patients in both studies received a single IFX infusion). Conversely, our early colectomy rate of 19% is very close to the 21% reported by Laharie et al in the ciclosporin versus infliximab open-label randomised controlled trial, in which a standard 3 dose IFX induction regimen was used.…”

“…26,27 Conversely, in studies with IFX as rescue therapy, CRP is related to the risk of colectomy in some studies, 22,28 but not in others. 23 The severity of endoscopic lesions, particularly the presence of deep or large ulcers, has been associated with the risk colectomy in several studies.…”

Review article: the practical management of acute severe ulcerative colitis

“…A Canadian cohort study similarly found that 16/21 patients (76%) with severe UC avoided early colectomy following infliximab, with 13/21 (62%) remaining colectomy‐free at 3‐month follow‐up . Comparable findings were described in a Danish multicentre analysis, with infliximab administration to glucocorticoid nonresponders with ASUC resulting in 61% (34/56) colectomy‐free survival when followed up after a median of 1.5 years …”

“…Unlike in previous studies, maintenance therapy used did not influence relapse rates. This was mirrored in a study by Mortensen et al ., who noted a lower colectomy rate in patients given three or more infusions (6/24 – 25% colectomy rate after a median of 9 months) when compared to patients given a single infusion only (13/26 – 50% colectomy rate after a median of 7 days) …”

Efficacy, safety, and predictors of response to infliximab therapy for ulcerative colitis: A Korean multicenter retrospective study

“…In addition, infliximab was superior to placebo for inducing mucosal healing, which is a strong predictor of favorable long‐term outcome . Data from retrospective observational studies showed that infliximab rescue therapy was effective in avoiding colectomy in acute, severe, steroid‐refractory UC patients . Despite well‐known adverse events, such as infusion reaction and risk of opportunistic infection, it has been reported that infliximab treatment is safe and tolerable in most of UC patients .…”