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INFLIXIMAB FOR THE TREATMENT OF HOSPITALIZED PATIENTS WITH INFLAMMATORY BOWEL DISEASE
GM Lai, CH Seow, JM Stempak, AH Steinhart, GR Greenberg, MS Silverberg
Inflammatory Bowel Disease Centre, Mount Sinai Hospital, Toronto
BACKGROUND: Inflammatory Bowel Disease (IBD) comprises Crohn’s Disease (CD) and Ulcerative Colitis (UC). These chronic relapsing conditions of the gastrointestinal tract necessitate maintenance therapy, and sometimes hospital admission. Tumour Necrosis Factor-alpha (TNF-alpha) is a potent pro-inflammatory cytokine. Infliximab, a monoclonal IgG1 antibody that binds to TNF-alpha, has been shown to be effective in inducing remission and preventing relapse in patients with steroid-dependent and steroid-refractory IBD.
AIM: To assess the effectiveness and safety of infliximab in hospitalized patients with IBD.
METHODS: An audit was performed of all adult patients hospitalized at Mount Sinai Hospital who received infliximab for the treatment of IBD between the years 2002-2007. The primary endpoint was corticosteroid withdrawal. Secondary endpoints included adverse events, need for surgery, proportion achieving remission and/or clinical response as defined by the Mayo clinical score.
RESULTS: Seventy-two IBD patients were reviewed (37 CD / 33 UC / 2 IBDU). Mean age was 32.6 years (19-68.9). 53 % were male. Mean follow up was 2.0 years. Fifteen patients (21 %) were able to cease steroid use; there were nine (12%) self-limiting infusion reactions in nine of the patients; two (2.6 %) non-life threatening infections occurred; nine patients (12.5 %) required surgery within 3 months of receiving infliximab (3 CD/ 6 UC), with a further seventeen patients (24 %) requiring surgery after 3 months (12 CD/ 5 UC). There were 47 patients (65 %) who achieved a clinical response; and 29 patients (40%) who entered remission.
CONCLUSIONS: Infliximab appears effective in permitting corticosteroid withdrawal and in inducing response and remission in hospitalized IBD patients without causing serious adverse events. A proportion of patients still require surgery. Further studies are required to determine if earlier infliximab therapy may further improve outcomes.