P496. Efficacy of infliximab therapy in acute and sub-acute ulcerative colitis
D. Cheema, E. Harrison, M. Nizamuddin, J. Slater, L. Wood, S. Ishaq, S. Cooper, S. de Silva, The Dudley Group NHS Foundation Trust, Gastroenterology, Dudley, United Kingdom
Ulcerative colitis is a chronic relapsing and remitting inflammatory disease with almost a third of acute severe cases needing rescue therapy. Infliximab is NICE (National Institute for Health and Care Excellence) approved in the UK for treating acute severe UC and moderate to severely active UC that is non-responsive to conventional therapy, however limited data exists with respect to long term outcomes.
We conducted a single centre retrospective review of patients with UC who had received infliximab between July 2006 and August 2013. Patients were grouped according to whether they had received infliximab for either an acute or sub-acute exacerbation of ulcerative colitis. Emergency admissions who failed to respond to intravenous steroids were defined as acute ulcerative colitis. Elective admissions who had failed to respond to maximum oral therapy, including immunomodulators and oral steroids, were defined as sub-acute ulcerative colitis. Data gathered included all treatment received, colectomy rates, CRP and platelet count at presentation and smoking status. Fisher's exact or Mann–Whitney U analysis was performed.
50 patients received 1–6 doses of infliximab in the 85 month period studied, 23 for acute and 27 for sub-acute ulcerative colitis. The majority of patients (70%) received 3 loading doses only, then up to 3 further maintenance doses if indicated. In the acute group 15 patients (65%) avoided colectomy, with a median follow-up of 38 months. 73% of the acute patients who avoided colectomy were immuno-naive. In the sub-acute group 21 patients (78%) avoided colectomy, with median follow-up of 29 months. All patients in the sub-acute group had previously been exposed to immunomodulators.
Infliximab has potential benefits in the treatment of both acute and sub-acute ulcerative colitis. Immuno-naive patients with acute ulcerative colitis are more likely to benefit from infliximab than those patients previously exposed to immunomodulator therapy (p = 0.04). In addition, all acute patients and 86% of sub-acute patients, who avoided colectomy, were well and off steroids at the end of follow-up. This supports the use of infliximab in these groups of patients with ulcerative colitis.