Infliximab as a Rescue Therapy for Hospitalized Patients with Severe Ulcerative Colitis Refractory to Systemic Corticosteroids

Abstract

Background: Infliximab therapy is effective for the induction and maintenance of clinical remission in patients with moderate to severe ulcerative colitis. However, it has not been studied extensively in hospitalized patients who require colectomy as a rescue therapy for severe ulcerative colitis refractory to intravenous corticosteroids. Aim: To evaluate the effectiveness of infliximab in hospitalized patients with severe ulcerative colitis refractory to intravenous corticoids as a rescue therapy before colectomy. Methods: 10 severe ulcerative colitis patients refractory to intravenous hydrocortisone administered for at least 7 days and candidate for colectomy were selected to receive a single infusion of infliximab (5 mg/kg). Results: 8 patients failed to respond to infliximab and required colectomy during the hospitalization period. The median time to operation after infliximab infusion was 21 days. Of 8 patients, 6 had a partial clinical response manifested by a decreasing number of bowel movements and rectal bleeding during 7–14 days after the infliximab infusion, and the remaining 2 patients showed a lack of response to infliximab infusion. Conclusion: These results suggest that a single infliximab infusion seems to be ineffective as a rescue therapy of colectomy in hospitalized patients with severe ulcerative colitis refractory to systemic corticosteroids.

Clinical trial: colectomy after rescue therapy in ulcerative colitis – 3‐year follow‐up of the Swedish‐Danish controlled infliximab study

“…Our short‐term results are supported by uncontrolled studies, reporting colectomy frequencies between 15% and 33% during the first few months 19–21 . However, higher figures of up to 75–80% have been reported elsewhere 22, 23 …”

Outcomes of salvage therapy for steroid-refractory acute severe ulcerative colitis: ciclosporin vs. infliximab

“…The rates of short‐ and medium‐term response induced by IFX are higher than those reported in other, smaller series . However, the data are markedly similar to studies with comparative patient selection criteria and sample size .…”

Thalidomide: an emerging drug in oral mucosal lesions

“…Again, colectomy rates differed, ranging from 11% to 60% with equally differing duration follow-up. A review of the uncontrolled studies with higher cumulative colectomy rates appear to include patients with more severe disease; criteria such as “severely ill” (Aratari)62 and “candidate for colectomy” (Yamamoto-Furusho)61 were used to select patients for infliximab in these studies.…”