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P524. Efficacy of infliximab treatment in acute severe ulcerative colitis

S. Gokturk1, O. Mutluay Soyer1, A. Ciftcibasi Ormeci1, B. Baran1, S. Evirgen1, F. Akyüz1, Ç. Karaca1, K. Demir1, F. Besisik1, S. Kaymakoglu1, 1Istanbul School of Medicine, Gastroenterohepatology, Istanbul, Turkey

Background

Approximately 25% of ulcerativecolitis (UC) cases show a severe progression. 30–40% of these cases are resistant to steroid. Cyclosporine has been used in the rescue therapy of steroid resistant UK. In recent years infliximab (IFX) monoclonal anti-TNF antibody also commenced to be used in severe steroid resistant UK. The aim of the study is to investigate the efficacy of IFX in steroid resistant or steroid dependent UK.

Methods

The study population comprised 17 patients with corticosteroid-refractory or steroid dependent acute severe UC treated with infliximab. IFX dose was (5 mg/kg, 3 dosage). The demographic and clinical features of the patients were recorded. The disease activity was defined according to Truelove–Witts criteria. Following the infliximab treatment, the regression in disease activity was defined as to be a response to the treatment.

Results

10 (59%) of the patients were male and mean age 42±3.7 (19–75) years, mean disease age 39±9.7 months, and mean follow-up period 25.6±4.6 months. 59% (10) of with pancolits involvement, 17% (3) with extended involvement, 12% (2) with left colon involvement, and 12% (2) with distal involvement. 77% (12) of thepatients were steroid resistant and 23% (5) were steroid dependent. After the three dosage of IFX induction, 53% (9) of patients achieved remission, 41% (7) unresponsive, and 6% (1) partial response. After three dosage, the unresponsive one of the patients entered into remission four months later, and the other showed partial response while in 24% (4) of the patients colectomy was required and 6% (1) of them died. At the end of the follow up period 70% (12) are still in remission. For the maintenance treatment; 17% (2) of the patients take mesalamin, and 58% (7) mesalamin as well as last longing immunosuppresive. While from 3 patients have ankilozanspondilit, 2 (17%) of them are given infliximab, and 1 (8%) take adalimumab for maintenance.

Conclusion

Infliximab is effective nearly two thirds of the patients in rescue therapy for acute severe steroid-refractory or steroid dependent UK.