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P499 Long-term outcomes of infliximab and predictors of response in 213 patients with ulcerative colitis: a hospital-based cohort study from Korea

H. Seo*1, S. H. Park1, K. Chang1, G.-U. Kim1, E. M. Song1, M. Seo1, H.-S. Lee2, S.W. Hwang1, D.-H. Yang1, B. D. Ye1, J.-S. Byeon1, S.-J. Myung1, S.-K. Yang1

1Asan Medical Centre, University of Ulsan College of Medicine, Department of Gastroenterology, Seoul, South Korea, 2Asan Medical Centre, University of Ulsan College of Medicine, Health Screening and Promotion Centre, Seoul, South Korea

Background

Large scale studies regarding long-term efficacy of infliximab (IFX) treatment in non-Caucasian patients with ulcerative colitis (UC) are lacking.

Methods

We retrospectively analysed long-term outcome of IFX treatment in 213 Korean UC patients who received scheduled IFX treatments at Asan Medical Centre between December 2006 and November 2015. Two outcome measures were studied, namely: IFX discontinuation because of colectomy or non-response to IFX and IFX failure, which was defined by UC-related hospitalisation or need for corticosteroids as a rescue therapy during the course of IFX treatment.

Results

During a median (IQR) follow-up of 13 (1.43–3.5) months, a total of 2,651 infusions of IFX (2 523 infusions of Remicade and 128 infusions of Remsima) were administered to 213 patients, with a median (IQR) of 9 (3–20) infusions. At the end of the follow-up, 55 patients (25.8%) stopped IFX treatment because of colectomy (23 patients, 10.8%) and non-response to IFX (32 patients, 15.0%). Additionally, 39 patients (18.3%) experienced IFX failure during the follow-up because of UC-related hospitalisation (24 patients, 11.3%) or need for corticosteroids as a rescue therapy (15 patients, 7.0%). The survival free of IFX discontinuation because of colectomy or non-response to IFX was 75.7% at 1 year, 71.2% at 2 years, and 71.2% at 5 years (Figure 1). The survival free of IFX failure was 58.8% at 1 year, 50.5% at 2 years, and 42.7% at 5 years (Figure 2). In a multivariate regression analysis, male gender (p = 0.040, hazard ratio 1.90, 95% CI 1.03–3.49), a severe disease activity at the initiation of IFX (Mayo score ≥ 11, p = 0.019, hazard ratio 2.00, and 95% CI 1.12–3.55), and a history of CMV colitis within 3 months before initiation of IFX (p = 0.022, hazard ratio 1.89, and 95% CI 1.10–3.26) were the predictors of IFX discontinuation because of colectomy or non-response to IFX. Steroid refractoriness was the only predictor of IFX failure (p = 0.026, hazard ratio 1.65, and 95% CI 1.06–2.55).

Figure 1. The survival free of IFX discontinuation because of colectomy or non-response to IFX.

Figure 2. The survival free of IFX failure.

Conclusion

The long-term efficacy of IFX in a large, real-life cohort of Korean patients with UC appears to be similar to that in previously published Western studies.