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A SINGLE-CENTRE EXPERIENCE WITH INFLIXIMAB IN THE TREATMENT OF HOSPITALIZED PATIENTS WITH SEVERE, STEROID-REFRACTORY ULCERATIVE COLITIS
P Tartaro, TP Ponich
Division of Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ontario
PURPOSE: Since the publication of ACT1 and ACT2, infliximab has become an important treatment option for patients with moderate to severe ulcerative colitis in the outpatient setting. Limited data exists on the outcomes of hospitalized patients with severe, steroid-refractory disease who are prescribed infliximab during their hospital course. We report our experience with 15 adult biologic-naïve patients who were prescribed infliximab during their hospitalization for severe, steroid-refractory ulcerative colitis.
METHODS: All inpatient use of infliximab from March 2005 to March 2007 at London Health Sciences Centre was identified through a central pharmacy database. A total of 15 adult biologic-naive patients with ulcerative colitis (8 male, 7 female) were identified who were treated with infliximab after a non-response to intravenous corticosteroids. The hospital charts and office charts of their IBD specialist were reviewed. The main outcome identified was colectomy at discharge and at last available follow-up. Other data collected included duration of disease, extent of disease, concomitant immunomodulator use, discontinuation of infliximab, and ability to discontinue corticosteroids. Follow-up data was available for a minimum of 6 months after initial infliximab therapy.
RESULTS: Three patients required a colectomy at the same admission at which infliximab was given. The other 12 patients had symptomatic improvement allowing discharge from hospital. Three of the 12 patients who were discharged after infliximab therapy ultimately underwent colectomy. The time to colectomy ranged from 2 to 16 months after discharge. Of the 9 remaining patients who did not undergo colectomy, 6 remained on maintenance infliximab (3 with concomitant azathioprine). One of the 9 patients had a recurrence of symptoms after being stable on infliximab for 2 years but then entered remission with a different biologic agent as part of a clinical trial. The last 2 of the 9 patients received only one to three doses of infliximab after discharge from hospital, however both patients were maintained on azathioprine therapy. All patients who did not undergo colectomy were completely tapered off corticosteroids.
CONCLUSIONS: A total of 9/15 (60%) biologic-naïve patients who received infliximab during a hospitalization for severe, steroid-refractory ulcerative colitis remained free of colectomy at a minimum follow-up of 6 months.