Long‐term outcome of infliximab treatment in chronic active ulcerative colitis: a Swedish multicentre study of 250 patients

• Published in: Alimentary pharmacology & therapeutics Vol. 45; no. 4; pp. 519 - 532
• Main Authors: Angelison, L., Almer, S., Eriksson, A., Karling, P., Fagerberg, U., Halfvarson, J., Thörn, M., Björk, J., Hindorf, U., Löfberg, R., Bajor, A., Hjortswang, H., Hammarlund, P., Grip, O., Torp, J., Marsal, J., Hertervig, E.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.02.2017
• Subjects: Adolescent; Adult; Aged; Antibodies, Monoclonal - therapeutic use; Azathioprine; Azathioprine - therapeutic use; Basic Medicine; Colectomy - trends; Colitis, Ulcerative - diagnosis; Colitis, Ulcerative - drug therapy; Colitis, Ulcerative - epidemiology; Colon; Farmakologi och toxikologi; Female; Follow-Up Studies; Gastrointestinal Agents - therapeutic use; Humans; Immunotherapy; Inflammatory bowel disease; Infliximab; Infliximab - therapeutic use; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Medicinska och farmaceutiska grundvetenskaper; Middle Aged; Monoclonal antibodies; Patients; Pharmacology and Toxicology; Remission; Remission Induction; Retrospective Studies; Steroids - therapeutic use; Sweden - epidemiology; Treatment Outcome; Tumor necrosis factor-α; Ulcerative colitis; Young Adult; Sweden
• ISSN: 0269-2813; 1365-2036; 1365-2036
• DOI: 10.1111/apt.13893

Summary Background Real‐life long‐term data on infliximab treatment in ulcerative colitis are limited. Aim To study the long‐term efficacy and safety of infliximab in chronic active ulcerative colitis and possible predictors of colectomy and response were also examined. Methods A retrospective multi‐centre study of infliximab treatment in 250 patients with chronic active ulcerative colitis with inclusion criteria: age ≥18 years, ambulatory treated, steroid‐dependent or intolerant and/or immunomodulator refractory or intolerant. Results Steroid‐free clinical remission was achieved by 123/250 patients (49.2%) at 12 months and in 126/250 patients at a median follow‐up of 2.9 years (50.4%). Primary response at 3 months was achieved by 190/250 (76.0%) patients and associated with a high probability of response 168/190 (88.4%) at 12 months and 143/190 (75.3%) at follow‐up. Long‐term rate of colectomy in primary responders was 6/190 (3.2%) at 12 months and 27/190 (14.2%) at last follow‐up. Failure to achieve response at 3 months was associated with a high risk of subsequent colectomy, 29/60 (48.3%) at 12 months and 41/60 (68.3%) at follow‐up. Response at 12 months was associated with a low risk of subsequent colectomy, 14/181 (7.7%) compared with non‐response 19/34 (55.9%) (P < 0.0001). Non‐response at 3 months was an independent predictor of subsequent colectomy (HR = 9.40, 95% CI = 5.10–17.35, P < 0.001). Concomitant azathioprine therapy did not influence outcome in terms of colectomy. Conclusions Long‐term efficacy of infliximab treatment in chronic active ulcerative colitis is excellent especially in patients who respond to induction treatment. Conversely, non‐response at 3 months predicts a poor outcome, with a high risk of subsequent colectomy. Linked ContentThis article is linked to Kilincalp et al and Angelison et al papers. To view these articles visit https://doi.org/10.1111/apt.13993 and https://doi.org/10.1111/apt.14003.