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P163. Outcomes of treatment with infliximab for ulcerative colitis and predictors of sustained clinical response

M. Bortlík1, D. Ďuricová1, K. Malíčková2, N. Machková1, V. Komárek1, E. Bouzková1, M. Lukáš1

1IBD Clinical and Research Center ISCARE and 1st Medical Faculty, Charles University, Prague, Czech Republic; 2Institution of Clinical Biochemistry and Laboratory Diagnostics, 1st Medical Faculty, Charles University, Prague, Czech Republic

Aim: The purpose of this study was to assess short- and long-term outcomes of infliximab therapy in patients with ulcerative colitis (UC) and to identify potential predictors of sustained clinical response.

Material and Methods: This was a retrospective, single center study on all UC patiens treated with infliximab between October 2007 and September 2010. Short-term (at week 10) and long-term clinical efficacy including colectomy-free survival were evaluated. Sustained response was defined as the absence of treatment failure due to loss of response or drug intolerance and no need for introduction of corticosteroids or their dose increase. The impact of disease duration, concomitant immunosuppressive therapy, and short-term endoscopic response at week 10 on sustained response were assessed. Kaplan–Meier curves with log rank test were used for statistical analysis.

Results: We enrolled 90 patients with UC (54% female, median age 32 years, (range 10–71)) who obtained 96 courses of IFX therapy. Over a median follow-up of 21 months (range 0–55) a median number of 8 (range 1–21) infusions were administered. Two thirds of patiens had extensive colitis, 31% had left-sided disease, and 3% of patients had proctitis. Eighty four percent of patients responded at week 10, while sustained response was observed in 55% of cases. At the end of follow-up only 13% of patients underwent colectomy. Among the initial responders, the probability of maintaining sustained response was 74%, 51%, and 27% at 1, 2, and 3 years, respectively. In the whole cohort of patients, the probability of maintaining the colectomy-free survival was 92%, 82%, and 79% at 1, 2, and 3 years, respectively. Duration of UC was inversely associated with the long-term efficacy. Two years after infliximab start the cumulative probability of sustained clinical benefit in patiens with disease duration of ≤2 and >2 years was 28% and 55% respectively (log rank test, p = 0.014). Neither concomitant immunosuppressive therapy, nor the short-term endoscopic response affected the long-term efficacy of infliximab.

Conclusion: Infliximab is highly effective in achieving clinical remission in patients with UC. However, the ability to keep sustained response seems to be lower as compared with Crohn's disease patients. Despite this fact, infliximab is very effective colon saving therapy.