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P533. Excellent long-term outcome in infliximab treated patients with chronic active ulcerative colitis

L. Angelison1, S. Almer2, U. Hindorf3, E. Hertervig3, 1Helsingborg Hospital, Dep. of Medicine, Helsingborg, Sweden, 2Linköping University, Dep of Gastroenterology, Linköping, Sweden, 3Skåne University Hospital, Dep of Gastroenterology, Lund, Sweden

Background

Infliximab has been shown to be effective in acute severe ulcerative colitis reducing the risk of colectomy. The ACT 1 and 2 studies have proven the efficacy of infliximab (IFX) in patients with a more chronic type of ulcerative colitis without imminent risk of colectomy. However, long-term data on clinical outcome of anti-TNF therapy in this population are scarce. The primary objective of this study was to assess long-term outcome of infliximab treatment in a real life setting, measured as steroid-free remission after 12 months and at last follow-up.

Methods

Retrospective capture of data from local registries at three outpatient clinics. Patients included had to be treated with IFX on an ambulatory basis. Further inclusion criteria were: age >18 years, a minimum of 8 weeks of steroids preceeding the index IFX infusion or more than 12 weeks of the last 6 months, intolerance to steroids, insufficient response to or intolerance to thiopurine therapy.

Results

Altogether 93 patients (52 males, 41 females) with a median age of 28.7 years (11.9–71.7) at diagnosis were included between 2005 and 2011. Median duration of disease until index IFX infusion was 4.2 years (0.2–36.3 years). At IFX start 79/93 (85%) were on 5-ASA, 39/93 (42%) on thiopurines and another 16/93 (17%) started a thiopurine together with IFX. Median follow-up per patient 3.7 years (0.1–7.8 years) and a median of 12 (1–41) infusions were given.

At 12 months 51/93 (54.8%) patients were in steroid-free remission and an additional 17/93 (18.3%) had steroid-free response. No response was noted in 11/93 (11.8%) and 9/93 (9.7%) had undergone colectomy. The corresponding figures at a median follow-up of 3.7 years were steroid-free remission: 50/93 (53.7%), steroid-free response 14/93 (15.0%), no response 5/93 (5.4%) and 18/93 (19.3%) had undergone colectomy. Of non-responders at 1 year 5/9 (55.5%) had undergone colectomy over the subsequent years. The main reasons for stopping IFX was remission in 30%, loss of response 30%, adverse events 18% and non-response 10%. Overall 22 patients were switched to adalimumab.

Conclusion

Infliximab is an efficacious long-term treatment in chronic ulcerative colitis with more than 50% of patients in steroid-free remission and less than 10% colectomized at 12 months. The high remission rate of over 50% was sustained at 3.7 years. In contrast, non-response at 12 months was connected to a very high risk of subsequent colectomy.