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Impact of mucosal healing on long‐term outcomes in ulcerative colitis treated with infliximab: a multicenter experience
Author(s) -
Laharie D.,
Filippi J.,
Roblin X.,
Nancey S.,
Chevaux J.B.,
Hébuterne X.,
Flourié B.,
Capdepont M.,
PeyrinBiroulet L.
Publication year - 2013
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.12289
Subject(s) - medicine , infliximab , ulcerative colitis , colectomy , gastroenterology , refractory (planetary science) , surgery , odds ratio , endoscopy , disease , astrobiology , physics
Summary Background Mucosal healing can be achieved with infliximab ( IFX ). Aim To assess the impact of mucosal healing on long‐term outcomes in patients with ulcerative colitis (UC) when treated with infliximab ( IFX ) beyond 1 year. Methods All consecutive adult patients with refractory UC receiving maintenance treatment with IFX in five French referral centres were analysed retrospectively. Only patients who had endoscopic evaluation between 6 and 52 weeks following IFX initiation were included. According to their Mayo endoscopic sub‐score, patients were categorised into mucosal healing (sub‐score: 0–1) and no mucosal healing (2–3). Outcome measures were colectomy and IFX failure defined by drug withdrawal due to secondary failure among primary responders. Results Of the 63 patients (30 women; median age: 38 years), 30 (48%) achieved mucosal healing. The median follow‐up duration was 27 (3–79) months. Colectomy‐free survival rates at 12, 24 and 36 months were, respectively, 100%, 96% and 96% in patients with mucosal healing. The corresponding figures were, respectively, 80%, 65% and 65% in patients without mucosal healing ( P = 0.004). By multivariate analysis, mucosal healing was the only factor associated with colectomy‐free survival, with an odds ratio of 18.01 (95% CI : 1.58–204.92). IFX failure‐free survival rates at 12, 24 and 36 months were, respectively, 76%, 69% and 64% in patients with mucosal healing, and 44%, 25% and 21% in those without mucosal healing ( P = 0.003). Conclusion Patients with refractory UC who achieved mucosal healing after IFX initiation had better long‐term outcomes, with significantly less colectomy and less IFX failure.