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Outcomes after escalation of infliximab therapy in ambulatory patients with moderately active ulcerative colitis
Author(s) -
Rostholder E.,
Ahmed A.,
Cheifetz A. S.,
Moss A. C
Publication year - 2012
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/j.1365-2036.2011.04986.x
Subject(s) - medicine , infliximab , ulcerative colitis , ambulatory , colectomy , maintenance therapy , cohort , retrospective cohort study , surgery , chemotherapy , disease
Summary Background Infliximab ( IFX ) therapy escalation during maintenance treatment occurs frequently in clinical practice in patients with ulcerative colitis ( UC ). Outcomes for these patients have not been described. Aim To describe the prevalence of, and outcomes after, IFX escalation during maintenance therapy in patients with moderate–severe UC . Methods Retrospective observational study of clinical outcomes in ambulatory patients with moderate–severe UC treated with maintenance IFX . Results Fifty‐six ambulatory patients received IFX for moderate–severe UC ; fifty (89%) responded and proceeded to maintenance therapy. Mean duration of maintenance therapy was 14 months, with mean follow‐up of 38 months. Twenty‐seven patients (54%) required IFX therapy escalation after a mean of six maintenance infusions. Clinical remission was noted in 36% of the entire cohort (18/50) at 12 months; 19% in the escalation group and 56% in the non‐escalation group. Patients who required IFX escalation were less likely to be in clinical remission at 12 months ( OR 0.2, 95% CI 0.1–0.6, P = 0.01) when compared with those who did not. During the follow‐up period, 27% of patients required a colectomy, and the mean time to colectomy was 17 months. Patients in the escalation group required a colectomy in 33% of cases, compared with 21% of non‐escalation patients. Conclusions A significant proportion of ambulatory patients with UC treated with maintenance infliximab required therapy escalation over time. This was associated with lower remission, and higher colectomy, rates.