Long term outcomes of single dose infliximab bridging therapy in severe ulcerative colitis.

Introduction Of patients with fulminant ulcerative colitis (UC), 30-40%are refractory to intravenous corticosteroids, with colectomy in 38-60%.Recently announced data from the only prospective, randomised trialcomparing infliximab and cyclosporin in acute severe colitis showed nosuperiority of cyclosporin in short-term treatment response nor threemonthcolectomy rate. Maintenance infliximab therapy is not publicly funded for ulcerative colitis in Australia; its emergency use to preventcolectomy in steroid-refractory disease may be a temporising measure toallow effective maintenance therapy with an immunomodulator to takeeffect.We report on the outcomes of our practice of using a single dose ofhospital funded infliximab as rescue bridging therapy in immunomodulatornaive or undertreated patients with severe, steroid-refractory UC in atertiary referral hospital.Methods Patients from a retrospectively identified cohort (AGW 2009A312, AGW 2010 A95) and subsequent prospectively identified patientsadmitted to Southern Health who received infliximab therapy for intravenouscorticosteroid resistant ulcerative colitis were followed and data onclinical parameters at the time of admission and subsequent progresscollected.Results Eighteen patients (age 17-54 (mean 38), 11 females) receivedinfliximab for severe UC (5 mg/kg) from January 2007 to May 2011.All patients were hospitalised with moderate to severe ulcerative colitisas defined by the Truelove and Witts criteria. Mean Mayo score was10.1 (+/- 1.6, range 6-12). Patients had received either no or inadequatelydosed immunomodulator therapy prior to admission. Intravenous corticosteroidswere given for 4-13 days prior to infliximab (mean 7.9 days),reflecting a frequent delay before consultation by the Inflammatory BowelDisease Unit. Follow-up was for a mean of 508 days (range 27-1079).Seventeen patients received a single dose of infliximab; one patientreceived six doses (intolerant to immunomodifiers). Colectomy free survivalrates