P399 Short- and long-term outcomes of infliximab treatment for refractory ulcerative colitis and associated prognostic factors: a Japanese single-center study
M. Nasuno*, M. Miyakawa, R. Sakemi, H. Tanaka, S. Motoya, A. Imamura
Sapporo-Kosei General Hospital, IBD center, Sapporo, HOKKAIDO, Japan
In Japan, infliximab (IFX) has been established as a useful treatment option for patients diagnosed with refractory ulcerative colitis (UC). However, the details of IFX treatment in Japanese patients with refractory UC remain unclear. The aim of this study was to analyze the short- and long-term outcomes of IFX treatment in patients with refractory UC and related prognostic factors.
Retrospective data were collected for 111 patients with refractory UC who received IFX treatment at the IBD Center, Sapporo Kosei General Hospital from July 2005 to November 2013. The Lichtiger clinical activity index (CAI) score of these subjects was >= 5. Remission was defined as a CAI score of <= 4. These scores were calculated at baseline as well as at 2 and 6 weeks and 1 year following IFX administration, and the cumulative colectomy rate following IFX administration was estimated using the Kaplan-Meier method. The prognostic factors that influenced remission rate and cumulative colectomy rate were evaluated using multivariate logistic regression analysis and multivariate Cox regression analysis, respectively.
Of the 111 subjects (mean age, 37.4 years), 47 were female. The mean duration of disease was 5.2 years and the mean CAI score at baseline was 9.4. 70 had total colitis, 39 had left-sided colitis and 2 had proctitis-type colitis. Concomitant treatment with immunomodulator (IM) was administered to 77% subjects. Previous treatment included calcineurin inhibitor treatment in 42 subjects. Steroid resistance was observed in 51 subjects, whereas 60 demonstrated steroid dependence. Remission rates at 2 and 6 weeks and 1 year were 46%, 58% and 48%, respectively. Previous treatment with calcineurin inhibitors was a significant prognostic factor for the lower remission rate at 6 weeks and 1 year, whereas concomitant IM was a significant prognostic factor for the higher remission rate at 6 weeks, as analyzed by multivariate logistic regression analysis. Sex (female) was also a significant prognostic factor only for the higher remission rate at 1 year. The 1-, 3-, and 5-year cumulative non-colectomy rates were 80%, 78% and 75%, respectively. Previous treatment with calcineurin inhibitors and total colitis type were poor prognostic factors that significantly decreased the cumulative non-operation rate. In contrast, sex (female) was a prognostic factor for the lower non-operation rate.
This retrospective study revealed good short- and long-term outcomes of IFX treatment in Japanese patients with refractory UC. Previous treatment with calcineurin inhibitors and total colitis type were prognostic factors for the poor outcomes of IFX treatment, whereas concomitant IM and sex (female) were prognostic factors for the good outcomes.