P328 Factors related to short- and long-term treatment results and usefulness of infliximab for refractory ulcerative colitis
Y. Takada*, S. Yasukawa, R. Amano, M. Yasaka, N. Takatsu, Y. Yano, F. Hirai
Fukukuoka University Chikushi hospital, Chikushino-shi, Japan
Infliximab (IFX) is highly useful for the treatment of refractory cases of ulcerative colitis (UC) and can potentially negate the need for surgery in such cases. This study investigated the factors involved in the short- and long-term treatment results and usefulness of IFX for refractory UC, as well as its safety.
In total, 72 patients with refractory UC who were started on IFX treatment between June 2010 and July 2015 were analysed. Distributions of patient background factors were sex, 38 men/34 women; mean disease duration, 118.3 months; pancolitis/left-sided colitis, 52/20; and initial attack type/relapse type/chronic persistent type, 4/41/27. Prior treatments included 5-ASA preparation, 69 patients (96%); prednisolone (PSL), 67 patients (93%); thiopurine preparation, 35 patients (49%); tacrolimus, 27 patients (38%); and cytapheresis, 20 patients (28%). Further, 20 patients were PSL-resistant, 47 were PSL-dependent, and 5 were PSL-naïve. Definitions of short-term treatment results, based on the p-Mayo score after 8 weeks of IFX treatment were ‘remission’, ≤ 1; ‘improved’, a decrease of ≥ 3 compared with baseline; and ‘ineffective’, all other scores. We went a comparison between the effective and ineffective groups. The long-term results were investigated in terms of the cumulative surgery-free rate and the relapse-free rate for the short-term effective cases. The safety of IFX was investigated in terms of the adverse reactions in the long-term treated cases and the methods used to treat those adverse reactions.
The short-term treatment results showed 26 remission cases (36.1%), 19 improved cases (26.3%) and 27 ineffective cases (37.5%). Many of the effective cases were those with extraintestinal symptoms (29/72 patients, 37.5%). The 3-year cumulative surgery-free rate was higher in the short-term effective group than in the short-term ineffective group (93.3% vs 55.6%). Relapse occurred in 12 of the 45 short-term effective group cases (26.7%). The 12 relapsed patients were treated by switching to adalimumab in 6 cases, administration of PSL in 4, shortening of the treatment period in 1, and performance of leukocytapheresis in 1. These changes were effective in 10 of the 12 patients. In addition, 10 patients experienced adverse reactions to IFX, and the drug was discontinued in 6. The most common symptom was rash.
The short-term efficacy rate of IFX in the refractory UC patients was around 63%, and surgery was avoided over the long-term in those short-term effective cases. The presence of extraintestinal symptoms was found to be a predictive factor for the medium- and long-term prognosis.