Brief Article
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World J Gastroenterol. Feb 21, 2013; 19(7): 1091-1097
Published online Feb 21, 2013. doi: 10.3748/wjg.v19.i7.1091
Efficacy of infliximab in acute severe ulcerative colitis: A single-centre experience
Stephen J Halpin, P John Hamlin, Daniel P Greer, Lisa Warren, Alexander C Ford
Stephen J Halpin, P John Hamlin, Daniel P Greer, Lisa Warren, Alexander C Ford, Leeds Gastroenterology Institute, St. James’s University Hospital, Leeds, West Yorkshire LS9 7TF, United Kingdom
Alexander C Ford, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, West Yorkshire LS9 7TF, United Kingdom
Author contributions: Halpin SJ, Warren L, Greer DP, Hamlin PJ and Ford AC conceived and drafted the study; Halpin SJ, Warren L and Greer DP collected all data; Halpin SJ and Ford AC analyzed and interpreted the data, and drafted the manuscript; all authors commented on drafts of the paper and approved the final draft of the manuscript.
Correspondence to: Dr. Alexander C Ford, Leeds Gastroenterology Institute, St. James’s University Hospital, Room 125, 4th Floor, Bexley Wing, Beckett Street, Leeds, West Yorkshire LS9 7TF, United Kingdom. alexf12399@yahoo.com
Telephone: +44-113-2684963 Fax: +44-113-2429722
Received: November 17, 2012
Revised: December 22, 2012
Accepted: December 25, 2012
Published online: February 21, 2013
Processing time: 97 Days and 6.7 Hours
Abstract

AIM: To suggest infliximab (IFX) is effective for acute severe ulcerative colitis, from real-life clinical practice.

METHODS: All patients receiving IFX for the treatment of acute severe ulcerative colitis in a single centre were included. Data were extracted from clinical records in order to assess response to IFX therapy. The primary endpoint was colectomy-free survival, and secondary outcomes included glucocorticosteroid-free remission and safety, which was evaluated by recording deaths and adverse events. Demographic and clinical characteristics of those who underwent colectomy and those who were colectomy-free, both at discharge from their index admission, and during follow-up after an initial response to IFX were compared.

RESULTS: Forty-four patients (16 females, mean age 36 years) received IFX between May 2006 and January 2012 for acute severe ulcerative colitis. The median duration of follow-up post-first infusion was 396 d (interquartile range = 173-828 d). There were 21 (47.7%) patients with < 1 year of follow-up, 10 (22.7%) with 1 years to 2 years of follow-up, and 13 (29.5%) with > 2 years of follow-up post-first infusion of IFX. Overall, 35 (79.5%) responded to IFX, avoiding colectomy during their index admission, 29 (65.9%) were colectomy-free at last point of follow-up (median follow-up 396 d), and 25 (56.8%) were in glucocorticosteroid-free remission at end of follow-up. There was one death from post-operative sepsis, 20 d after a single IFX infusion. Colectomy rates were generally lower among those “bridging” to thiopurine. Of 18 patients “bridged” to thiopurine therapy, 17 (94.4%) were colectomy-free, and 15 (83.3%) were in glucocorticosteroid-free remission at study end. No predictors of response were identified.

CONCLUSION: IFX is effective for acute severe ulcerative colitis in real-life clinical practice. Two-thirds of patients avoided colectomy, and more than 50% were in glucocorticosteroid-free remission.

Keywords: Ulcerative colitis; Severe; Azathioprine; Infliximab; Remission