P451 The efficacy of infliximab in tacrolomus non-responder with ulcerative colitis
T. Miyazaki*, N. Hida, T. Sato, M. Kawai, K. Kamikozuru, T. Takagawa, Y. Yokoyama, M. Iimuro, K. Hori, S. Nakamura
Hyogo College of Medicine, Division of Internal Medicine Department of Inflammatory Bowel Disease, Nishinomiya, Japan
Infliximab (IFX) and tacrolimus are effective in corticosteroid-refractory ulcerative colitis (UC). However, the efficacy of IFX in UC patients who failed to respond tacrolimus is unclear. We evaluated the therapeutic efficacy of IFX in refractory UC who failed to respond to tacrolimus.
We retrospectively investigated the effects of IFX in 27 UC patients who did not respond to tacrolimus at our hospital. We assessed the data for disease activity (Mayo score [MS]; remission MS ≤ 2, improvement; ≥ 1 decrease for each score). We collected the data of characteristics (sex, age, duration of UC, extent of UC, corticosteroids-resistant or corticosteroids-dependent nature, clinical course, and dosage of corticosteroids).
Amongst 27 UC patients treated with IFX, there were 19 males and 8 females, and their mean age was 35.3. Disease locations for patients with refractory UC were pancolitis (24) and left-sided colitis (3); 9 patients had steroid-dependent UC, and 18 patients had steroid-resistant UC. The mean duration of UC was 77.8 months, and the mean duration of IFX treatment was 15.4 months. The response rate was 63.0%, and the remission rate was 51.9% after 12 weeks. Further, 8 of 27 patients maintained remission after 12 months. The average dose of prednisolone was 18.9 mg/day at baseline, and 5.9 mg/day at the end of observation. The steroid-free remission rate was 42.1%. The colectomy-free survival rates were 85.19% and 75.16%, respectively, at 12 months and 24 months. There was no significant difference in the characteristics between patients who responded to IFX and those who did not respond, whereas the colectomy rate was higher in patients aged 40 or older than in those less than 40 years of age. (The colectomy rate was 62.5% in patients aged 40 or older, whereas 10.5% in those less than 40 years of age at the end of observation.) No serious adverse events occurred.
IFX was more effective and potential treatments to avoid colectomy in UC patients who did not response to tacrolimus. We should select therapy of IFX carefully in elderly UC patients because colectomy rate was high in patients aged 40 or older.