Infliximab for treatment of steroid-refractory ulcerative colitis.

Abstract

BACKGROUND:

Success achieved in two subtypes of Crohn's disease has persuaded a few investigators to experiment the monoclonal anti-tumour necrosis factor antibody infliximab in the treatment of ulcerative colitis. So far, however, the results (achieved in some 30 steroid-refractory patients included in two independent full-papers) indicate a rate of initial response of 50% and of remission of 25%.

AIMS:

To analyse data of an open trial conducted on consecutive steroid-refractory severely ill patients admitted to our referral Unit.

PATIENTS AND METHODS:

In 9 months, infliximab was given to 8 patients (4 male, 4 female aged 20-60 years) with uncontrolled ulcerative colitis of whom 6 were non-responders to parenteral steroids. All received the first infliximab dose as an intravenous infusion of 5 mg/kg.

RESULTS:

Of the 8, 4 (50%) did not respond to the first injection and were submitted to urgent colectomy; the other four responded clinically. Two have maintained clinical remission for 7 months, without the need for steroids; both have received daily azathioprine at 2 mg/kg, and only one has received two further infliximab injections. Of the other two, one received a second injection at week 5, despite this relapsed, and underwent elective colectomy at that time; the other relapsed at 6 months and showed a partial response to a repeat infliximab infusion. Thus, the rate of sustained response is 2/8 (25%) in this study.

CONCLUSION:

These results, achieved in an open uncontrolled fashion, seem to reflect those of other independent studies. In our opinion, these findings warrant an in-depth reappraisal of the indication to use infliximab as rescue treatment for refractory ulcerative colitis.

• Authors: G C Actis, M Bruno, M Pinna-Pintor, F P Rossini, M Rizzetto
• Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (Dig Liver Dis) Vol. 34 Issue 9 Pg. 631-4 (Sep 2002) ISSN: 1590-8658 [Print] Netherlands
• PMID: 12405249 (Publication Type: Evaluation Study, Journal Article)

Chemical References

• Antibodies, Monoclonal
• Gastrointestinal Agents
• Tumor Necrosis Factor-alpha
• C-Reactive Protein
• Infliximab

Topics

• Adult
• Antibodies, Monoclonal (therapeutic use)
• C-Reactive Protein (analysis)
• Colitis, Ulcerative (classification, drug therapy)
• Female
• Gastrointestinal Agents (therapeutic use)
• Humans
• Infliximab
• Male
• Middle Aged
• Severity of Illness Index
• Treatment Outcome
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)