P621 Combination treatment of biologics with immunomodulator increases risk of infection after discharge in biologics naive steroid refractory acute severe ulcerative colitis patient: A KASID multicenter study
Kim, S.J.(1)*;Lee, J.(1);Kim, D.H.(2);Park, S.H.(3);Kim, E.S.(4);Kim, K.O.(5);Lee, Y.J.(6);Song, E.M.(7);Kim, D.S.(8);
(1)College of Medicine- Chosun University, Internal Medicine, Gwangju, Korea- Republic Of;(2)Chonnam National University Hospital and Medical School, Internal Medicine, Gwangju, Korea- Republic Of;(3)Asan Medical Center, Internal Medicine, Seoul, Korea- Republic Of;(4)School of Medicine- Kyungpook National University, Internal Medicine, Daegu, Korea- Republic Of;(5)Yeungnam University hospital, Internal Medicine, Deagu, Korea- Republic Of;(6)Keimyung University Hospital, Internal Medicine, Daegu, Korea- Republic Of;(7)Ewha Womans University Seoul Hospital, Internal Medicine, Seoul, Korea- Republic Of;(8)Konyang University Hospital, Internal Medicine, Daejeon, Korea- Republic Of; IBD Research Group in Korean Association for the Study of the Intestinal Diseases (KASID)
Biologics such as infliximab is the main treatment for steroid refractory acute severe ulcerative colitis (ASUC), However, there are only a few studies on the effectiveness and safety of biologics in steroid refractory ASUC. In this study, we evaluated the effectiveness and safety of biologics as a rescue therapy for biologics naïve steroid refractory ASUC patient in Korea.
We retrospectively included patients who were hospitalized at seven tertiary medical centers for ASUC management between January 2015 to December 2020, and data on the demographic and clinical variables, disease activity, treatment method, treatment response, adverse event, readmission due to any reasons were checked
A total of 230 ASUC patients were included, of which 220 were biologic naïve patient. The response rate of steroid in these patients was 74%, and infliximab was administered as rescue therapy to 53 patients who failed initial steroid treatment. The response rate to infliximab as rescue therapy was 96%, and 2 patients who did not respond received colectomy. One of the two patients who underwent colectomy died of sepsis. There was no infliximab-related adverse event during hospitalization. Although infliximab itself was not a factor associated with infection after discharge (10% vs. 16%, p=0.355), combination therapy with thiopurine was a risk factor for infection after discharge. (Odd ratio 7.302, 95% CI 2.101-25.372, p=0.002). A total of 12 infections occurred in patients treated with infliximab after discharge (3 pneumonia, 1 skin infection, 3 cytomegalovirus colitis, 4 Clostridium difficile infection) and were associated with readmission. (40.1% vs. 75%, p=0.031)
As a rescue therapy in biologics naive steroid refractory ASUC, infliximab showed a 96% therapeutic response. Although infliximab itself did not increase the risk of infection after discharge, the combination with thiopurine increased the risk of infection after discharge