Search in the Abstract Database

Search Abstracts 2011

* = Presenting author

P273. Short and long-term outcome of infliximab therapy is different in acute, steroid-refractory and chronic, steroid-dependent ulcerative colitis

K. Farkas, Z. Szepes, F. Nagy, T. Wittmann, T. Molnar

First Department of Medicine, University of Szeged, Szeged, Hungary

Introduction: There are only limited data about the short and long-term efficacy of infliximab (IFX) in patients with ulcerative colitis (UC) treated for different indications. Our aim was to compare the efficacy and safety of IFX in acute steroid-refractory and in steroid dependent UC cases.

Patients and Method: Data of 50 UC patients (28 females, 22 males; mean age at the diagnosis 27.5 years) infused for acute exacerbation in 20 and for chronic refractory disease in 30 cases were analyzed. 24% of the patients have received three infusion induction therapy and 70% were on maintenance treatment. A total of 269 infusions were administered, the mean number of IFX infusions was 5.6/patient. The mean length of follow up was 15 months. We evaluated the disease activity by Mayo scores and inflammatory laboratory parameters at the beginning and the end of the induction therapy and after one-year treatment period. We also assessed the frequency of colectomy, side effects and acute or delayed infusion reactions. We additionally examined whether the gender, the extension of the disease and the disease duration at the time of the first IFX infusions are associated with the outcome of IFX therapy. Data were analyzed using Pearson's chi-square test.

Results: Complete remission was achieved after induction in 68% of patients with acute, and in 58% of patients with chronic disease. 60% of the patients with steroid-dependent and 40% of patients with steroid-refractory disease had sustained clinical remission at the end of the first year. The overall colectomy rate was 22%. The colectomy rate for acute, severe UC was 25%, vs. 20% of patients with chronic disease. Interestingly, IFX induction therapy was more frequently ineffective in females vs. males (p = 0.04). 16% of the patients had 9 episodes of acute, 8% had 5 episodes of delayed infusion reaction. IFX had to be discontinued in 4 patients because of the allergic reactions. One patient developed primary colonic lymphoma. The mortality rate was 0%.

Discussion: We revealed better initial outcomes of IFX in acute vs. chronic UC suggesting the early effectiveness of IFX in rescue therapy. However, it should be noted that the rate of colectomy free survival proved to be lower in the acute form of UC during the long-term follow up. Loss of efficacy was shown in almost half of the patients.