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. 2012 Mar;35(5):562-7.
doi: 10.1111/j.1365-2036.2011.04986.x. Epub 2012 Jan 13.

Outcomes after escalation of infliximab therapy in ambulatory patients with moderately active ulcerative colitis

E Rostholder  1 , A Ahmed, A S Cheifetz, A C Moss
Affiliations

Outcomes after escalation of infliximab therapy in ambulatory patients with moderately active ulcerative colitis

E Rostholder et al. Aliment Pharmacol Ther. 2012 Mar.

Abstract

Background: Infliximab (IFX) therapy escalation during maintenance treatment occurs frequently in clinical practice in patients with ulcerative colitis (UC). Outcomes for these patients have not been described.

Aim: To describe the prevalence of, and outcomes after, IFX escalation during maintenance therapy in patients with moderate-severe UC.

Methods: Retrospective observational study of clinical outcomes in ambulatory patients with moderate-severe UC treated with maintenance IFX.

Results: Fifty-six ambulatory patients received IFX for moderate-severe UC; fifty (89%) responded and proceeded to maintenance therapy. Mean duration of maintenance therapy was 14 months, with mean follow-up of 38 months. Twenty-seven patients (54%) required IFX therapy escalation after a mean of six maintenance infusions. Clinical remission was noted in 36% of the entire cohort (18/50) at 12 months; 19% in the escalation group and 56% in the non-escalation group. Patients who required IFX escalation were less likely to be in clinical remission at 12 months (OR 0.2, 95% CI 0.1-0.6, P = 0.01) when compared with those who did not. During the follow-up period, 27% of patients required a colectomy, and the mean time to colectomy was 17 months. Patients in the escalation group required a colectomy in 33% of cases, compared with 21% of non-escalation patients.

Conclusions: A significant proportion of ambulatory patients with UC treated with maintenance infliximab required therapy escalation over time. This was associated with lower remission, and higher colectomy, rates.

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Figures

Figure 1
Figure 1
CONSORT flow chart of outcomes of patients in cohort from baseline
Figure 2
Figure 2
Kaplan Meier failure plot of cumulative colectomy rate grouped according to escalation (blue line) / non-escalation (red line)
See this image and copyright information in PMC

Comment in

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