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Infliximab in steroid-dependent ulcerative colitis: effectiveness and predictors of clinical and endoscopic remission.
- Source :
-
Inflammatory bowel diseases [Inflamm Bowel Dis] 2013 Apr; Vol. 19 (5), pp. 1065-72. - Publication Year :
- 2013
-
Abstract
- Background: Up to 20% of patients with ulcerative colitis (UC) become steroid-dependent during their course. Thiopurines are recommended in steroid-dependent UC, but their efficacy is debated. Data exploring the use of infliximab in these patients are scarce. Aims of this study were to evaluate the effectiveness of infliximab in steroid-dependent UC and identify predictors of steroid-free remission, mucosal healing (MH), and colectomy.<br />Methods: Steroid-dependent UC patients were enrolled and intentionally treated with infliximab. The prospectively designed analyses evaluated (1) steroid-free clinical remission at 6 and 12 months, (2) steroid-free clinical remission and MH at 12 months, and (3) colectomy within 12 months.<br />Results: One hundred and twenty-six active steroid-dependent UC patients were studied. Of the 126 patients, 36 patients were retrospectively included and 90 patients prospectively enrolled. Steroid-free remission was 53% and 47% at 6 and 12 months, respectively. Predictors of steroid-free remission at 6 and 12 months were thiopurine-naive status (hazard ratio [HR], 2.5 and HR, 2.8, respectively) and combination therapy (HR, 2.1 and HR, 2.2, respectively). At 12 months, 32% were in steroid-free remission and MH. Thiopurine-naive status predicted steroid-free remission and MH (odds ratio, 3.6). C-reactive protein drop to normal after infliximab induction was predictive of steroid-free remission at 6 (HR, 5.9) and 12 months (HR, 4.6) and steroid-free remission and MH at 12 months (odds ratio, 6.0). Twelve patients underwent colectomy after a median of 4.7 months. Steroid sparing significantly reduced the risk of colectomy within 12 months (HR, 0.14).<br />Conclusions: Infliximab seems effective in steroid-dependent UC. Thiopurine-naive status and combination therapy significantly increase the rate of steroid-free remission up to 12 months.
- Subjects :
- Adult
C-Reactive Protein metabolism
Colitis, Ulcerative surgery
Combined Modality Therapy
Female
Follow-Up Studies
Humans
Infliximab
Male
Middle Aged
Prognosis
Prospective Studies
Remission Induction
Retrospective Studies
Anti-Inflammatory Agents, Non-Steroidal therapeutic use
Antibodies, Monoclonal therapeutic use
Colectomy statistics & numerical data
Colitis, Ulcerative drug therapy
Endoscopy
Steroids administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1536-4844
- Volume :
- 19
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Inflammatory bowel diseases
- Publication Type :
- Academic Journal
- Accession number :
- 23448790
- Full Text :
- https://doi.org/10.1097/MIB.0b013e3182802909