P331. Role of infliximab as rescue therapy in hospitalised patients with severe, steroid refractory ulcerative colitis. Local experience. Liverpool and Bankstown hospitals, South Western Sydney Local Health District. Australia
S. Vivekanandarajah1, M. Guirgis1, E. Bestic1, R.W.L. Leong2, J.H. Koo1, W. Ng1, S. Connor1
1South Western Sydney Local Health District, Liverpool hospital Gastroenterology Department, Sydney, Australia; 2South Western Sydney Local Health District, Bankstown Hospital Gastroenterology Department, Sydney, Australia
Background: To review outcomes in patients with severe steroid refractory/dependant ulcerative colitis (UC) requiring infliximab (IFX) as rescue therapy.
Methods: A retrospective review of medical records was performed for patients (June 2004 to September 2011) who received IFX in hospital for treatment of severe UC after failing to respond to IV steroids. Response was defined as avoidance of colectomy and steroid free remission. Disease activity was assessed using the MTWSI.
Results: In total, 30 patients have been treated. Median age at diagnosis of UC was 27 years (range 17–69); median age at treatment with IFX was 32.5 years (range 17–74 years). There were 20 male and 10 female patients. 40% of patients had left sided colitis, 50% had pancolitis and the remaining 10% had proctitis. 23 (76.6%) were on an immunomodulator. 1 patient had been previously treated with IFX, 1 failed trial tetomilast, 3 had been treated with visiluzimab and the other 25 were naïve to biologics. CMV was excluded in all but 2 patients. Median duration from diagnosis to IFX was 53.5 months (0–336 months) and the duration of flare before IFX was a median of 1 month (range 0–15). Median dose requirement was 3 infusions (range 1–6). MTWSI on day of infusion: 11 (3–17), day 7: 5 (4–14) and 8 weeks: 3 (0–13).
19 (63.3%) successfully avoided colectomy and 11 (36.7%) patients progressed to surgery. Long term follow up (>12 months) was available for 16 patients who avoided colectomy and all 16 patients remained colectomy free. The median duration from IFX to surgery was 58 days (1–213). Univariate analysis failed to identify predictors of requirement for surgery. In the rescued group 13 (68.4%) remained steroid free. Univariate analysis revealed male gender as the only factor which predicted successful cessation of steroids (OR: 7.5; 95% CI 0.78–78; P = 0.09). Only 3 patients developed complications: 1 steroid induced psychosis, 1 pancreatitis and neutropaenia secondary to thiopurine, and 1 thromboembolic stroke (precipitant unknown).
Conclusions: Results from this cohort of patients with severe steroid refractory and steroid dependent UC, indicate that colectomy was avoided in more than 60% of patients when IFX was administered. The long term colectomy rate in this group appears to be lower than historical data on cyclosporine treatment in the same setting. IFX use was also associated with lower rates of long term steroid requirement. There were no identifiable predictive factors for response and need for surgical intervention.