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213 RESCUE THERAPY WITH INFLIXIMAB COMPARED TO CYCLOSPORINE IN MODERATE TO SEVERE ULCERATIVE COLITIS A Rahman, R Sy INTRODUCTION: Recently, Infliximab has emerged as an alternative medical therapy in steroid refractory ulcerative colitis (UC). Two large randomized controlled trials have clearly demonstrated a benefit in treating outpatients with Infliximab in moderate to severe UC. The utility of Infliximab as rescue therapy in severe steroid refractory UC is less clear.
METHODS: To further clarify the role of Infliximab, we performed a retrospective chart review of all patients admitted with ulcerative colitis from April 31, 2004 to April 31, 2006 to the Ottawa Hospital. All charts with a diagnosis code for "ulcerative colitis" as a primary diagnosis were reviewed. In total, 119 admissions were reviewed. Of the 119 admissions, 62 were excluded due to admission for elective colectomy, surgical care post colectomy (ileoanal anastomosis/pouch procedure), and misdiagnosis or uncertain diagnosis of ulcerative colitis. 57 patients were eligible as a primary ulcerative colitis flare. Collected data included baseline identifying information (age, sex), stool frequency on admission, laboratory results, endoscopic grade of disease, extent of disease, primary treatments (steroids, Imuran/6-MP, 5-ASA), secondary treatments (cyclosporine, Infliximab), and colectomy.
RESULTS: 28 / 57 (49%) of admissions were steroid responsive. 18 / 57 (32%) were steroid non-responsive and went on to colectomy without secondary intervention. 8 patients did receive Infliximab, 6 of whom were responsive (75%) and avoided colectomy. 3 patients received cyclosporine, only 1 was responsive (33%). Though there is a trend suggesting Infliximab is superior to cyclosporine in treatment of severe steroid refractory UC, due to the small sample size, statistical significance was not met using Fisher's exact test for p<0.05.
CONCLUSION: Though not statistically significant, the use of Infliximab in steroid refractory ulcerative colitis may be promising. More data is needed to assess the utility of rescue Infliximab in severe ulcerative colitis unresponsive to steroids.