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P383 Short- and long-term outcomes of infliximab and calcineurin inhibitor treatment for steroid-refractory ulcerative colitis

S. Motoya*, M. Miyakawa, M. Nasuno, H. Tanaka

Sapporo-Kosei General Hospital, IBD Centre, Sapporo, HOKKAIDO, Japan

Background

Infliximab (IFX) and calcineurin inhibitors (CNI) are useful treatment options for inducing remission and avoiding colectomy in patients with steroid-refractory ulcerative colitis (UC). However, the optimal agent to be used as a second rescue therapy remains unknown. Moreover, the efficacy of sequential rescue therapies after a failed initial rescue is controversial. The aim of this study was to investigate the short- and long-term efficacies of second rescue and sequential rescue therapies for steroid-refractory UC.

Methods

Data were collected retrospectively from steroid-refractory UC patients treated with IFX or CNI (tacrolimus [TAC] or cyclosporin [CsA]) as a second rescue therapy at the IBD Centre, Sapporo Kosei General Hospital, between January 2009 and December 2013. Remission was defined as a Lichtiger clinical activity index (CAI) score of ≤ 4. Remission rates at 2 weeks and 3 months after the second rescue therapy were evaluated, and the cumulative maintenance remission rates were estimated using the Kaplan–Meier method. Moreover, the cumulative non-colectomy rates of 35 UC patients treated with the sequential rescue therapy were estimated using the Kaplan–Meier method.

Results

Of the 104 patients, 76 were treated with IFX and 28 with CNI (18 with TAC and 10 with CsA) for the second rescue therapy. The rate of concomitant use of immunomodulator and previous use of cytapheresis was higher in the IFX group (80% vs 50%, p = 0.006 and 89% vs 71%, p = 0.033, respectively). The remission rates at 2 weeks and 3 months were 50% and 63%, respectively, in the IFX group and 50% and 50%, respectively, in the CNI group. The 1- and 3-year maintenance remission rates for 62 patients who achieved clinical remission after the second rescue therapy were significantly better the IFX group than in the CNI group (98% and 74%, respectively, in the IFX group vs 71% and 36%, respectively, in the CNI group; p < 0.001, log-rank test). Sequential rescue therapies were performed in 35 of the 104 patients. Fifteen patients were treated with IFX as a sequential rescue therapy (CNI→IFX group) and 20 with CNI (IFX→CNI group). The 1- and 3-year non-colectomy rates were slightly, but not significantly, better in the CNI→IFX group (both 64%) than in the IFX→CNI group (53% and 36%, respectively; p = 0.138, log-rank test).

Conclusion

The remission-induction rates demonstrated with the second rescue therapies were similar, irrespective of the agent that was used first. However, the long-term efficacy for second rescue therapy with IFX was significantly better than that with CNI. Moreover, IFX sequential rescue therapy after a failed CNI second rescue therapy may be more effective compared with CNI sequential rescue therapy in terms of preventing colectomy.