JOURNAL ARTICLE
MULTICENTER STUDY

Infliximab in severe ulcerative colitis: short-term results of different infusion regimens and long-term follow-up

A Kohn, M Daperno, A Armuzzi, M Cappello, L Biancone, A Orlando, A Viscido, V Annese, G Riegler, G Meucci, M Marrollo, R Sostegni, A Gasbarrini, S Peralta, C Prantera
Alimentary Pharmacology & Therapeutics 2007 September 1, 26 (5): 747-56
17697208

BACKGROUND: Severe ulcerative colitis is a life-threatening disorder, despite i.v. glucocorticoids treatment. Infliximab has been proposed as a safe rescue therapy.

AIM: To evaluate short- and long-term effectiveness and safety of infliximab in severe refractory ulcerative colitis.

METHODS: Eighty-three patients with severe ulcerative colitis (i.v. glucocorticoids treatment-refractory) were treated with infliximab in 10 Italian Gastroenterology Units. Patients underwent one or more infusions according to the choice of treating physicians. Short-term outcome was colectomy/death 2 months after the first infusion. Long-term outcome was survival free from colectomy. Safety data were recorded.

RESULTS: Twelve patients (15%) underwent colectomy within 2 months. One died of Legionella pneumophila infection 12 days after infliximab. Early colectomy rates were higher in patients receiving one infusion (9/26), compared with those receiving two/more infusions (3/57, P = 0.001, OR = 9.53). Seventy patients who survived colectomy and did not experience any fatal complications were followed-up for a median time of 23 months; 58 patients avoided colectomy during the follow-up. Forty-two patients were maintained on immunosuppressive drugs. No clinical features were associated with outcomes.

CONCLUSIONS: Infliximab is an effective and relatively safe therapy to avoid colectomy and maintain long-term remission for patients with severe refractory ulcerative colitis. In the short term, two or more infusions seem to be more effective than one single infusion.

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