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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.