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P208. Long-term colectomy rate in severe steroid-refractory ulcerative colitis treated with infliximab as rescue therapy

A. Aratari1, V. Clemente2, P. Gentile1, G. Margagnoni1, P. Vernia2, M. Koch1, C. Papi1

1S. Filippo Neri Hospital, Rome, Italy, Rome, Italy; 2Department of Internal Medicine, University of Rome “Sapienza”, Rome, Italy, Rome, Italy

Background: In severe ulcerative colitis (UC) colectomy rate has remained stable during the last 30 years. Rescue therapy with Cya for steroid-refractory patients is effective in the short-term, but the colectomy rate in the long term is high. Recently infliximab (IFX) has been shown to be effective as rescue therapy in severe steroid-refractory UC, but little is known about long-term outcome.

Aim of the present study was to evaluate the long-term colectomy rate after an acute attack of severe UC in patients who responded to intravenous steroids and in steroid-refractory patients who responded to IFX as rescue therapy.

Patients and methods: All UC patients hospitalised for a severe attack between January 2003 and December 2009 were enrolled. All patients received intravenous steroids; IFX (5 mg/kg at 0, 2 and 6 weeks) was used as rescue therapy in steroid-refractory patients; colectomy was performed in patients who deteriorated whilst on steroids or in patients who failed to respond to IFX. Patients escaping colectomy during hospital stay were prospectively followed-up after discharge. Patients were classified in two groups: 1) patients responsive to iv steroids, and 2) patients steroid-refractory but responsive to IFX. The primary end-point was need of colectomy in the long term.

Results: Eighty-two patients were enrolled: 54 (66%) were steroid-responsive and 28 (34%) were steroid-refractory. Of these 5 (6%) underwent urgent colectomy and 23 received IFX as rescue therapy. All IFX-treated patients avoided colectomy during hospital stay. Overall 77 patients escaped colectomy during hospital stay: 54 steroid responsive (group 1) and 23 steroid-refractory but IFX responsive (group 2). Median follow-up was 23 months (range 1–78). During follow-up 12 additional patients underwent colectomy for recurrent symptoms: the overall colectomy rate (short and long term) after the acute attack was 20.7%. The cumulative probability of colectomy within 5 yrs in patients escaping colectomy during hospital stay was significantly higher in IFX-treated patients compared to steroid responsive patients. (Log Rank test p = 0.001).

Conclusions: Surgery continues to play an important role in acute severe UC. Steroid-refractory patients, despite IFX-induced remission, seem to have an increased risk of long-term colectomy compared to patients who respond to iv steroids.