Infliximab in Severe Ulcerative Colitis Delays and Prevents Early Colectomy

Infliximab in Severe Ulcerative Colitis Delays and Prevents Early Colectomy

According to a study published in the journal Clinical Gastroenterology and Hepatology, the use of infliximab in patients with acute severe ulcerative colitis reduces the need for early colectomy.

In the study titled “An Accelerated Infliximab Induction Regimen Reduces the Need for Early Colectomy in Patients With Acute Severe Ulcerative Colitis,” David Gibson from the Centre for Colorectal Diseaseat St Vincent’s University Hospital and School of Medicine and Medical Science in Ireland along with colleagues retrospectively evaluated 50 patients who were given two regimens of infliximab for steroid-refractory acute severe ulcerative colitis (ASUC).

The researchers divided the patients in two groups: the first group of 35 patients received a regimen of standard infliximab dosing at 0, 2, and 6 weeks and then every 8 weeks. The second group of 15 patients received an accelerated regimen and then three induction doses of infliximab for 24 days. The researchers then compared the rates of colectomy between the two groups throughout induction and after the follow-ups.

Results revealed that both groups had similar baseline levels of C-reactive protein, albumin, or hemoglobin. Compared with the standard group, the group under the accelerated regimen showed a reduction in the rate of colectomy during induction therapy. Moreover, the group that received a standard regimen had a shorter time to having a colectomy.

After the follow-up period colectomy rates were similar among the groups. In addition, results revealed that the efficacy of the induction therapy was related to the level of albumin when the treatment commenced and the accelerated dosing regimen.

“Despite the limitations, findings from this study suggest the need for further evaluation with prospective comparative studies of the effect of an [accelerated dosing] strategy, determined by [C-reactive protein], perhaps in combination with [infliximab] levels,” the researchers wrote according to a recent news release. “Observational studies such as ours provide useful clinical data to shape future treatment algorithms with a tailored dosing approach in acute severe disease when tumor necrosis factor (TNF) levels are at their highest. We believe an [accelerated dosing infliximab] induction should be considered in all patients with steroid-refractory [acute severe] UC who develop rebound inflammation before their next scheduled [infliximab] dose.”

According to results shown in an editorial by Hans. H. Herfarth, MD, PhD from the University of North Carolina in Chapel Hill, Gerhard Rogler, MD, PhD from the University of Zurich in Switzerland and Peter D. R. Higgins, MD, PhD, MSc, from University of Michigan, 24% of physicians used the standard dosing regimen for induction of remission in hospitalized patients with severe UC. “There appears to be a sub rosa movement in the inflammatory bowel disease community to try accelerated infliximab in severe UC, and the Gibson study provides data to support this approach,” the researchers wrote.

“At this point, it is critical to the field to conduct randomized multicenter clinical trials to identify the optimal dosing regimen for anti-TNF therapy in severe inpatient UC, and to identify the best monitoring strategies, evaluating the value of serum [C-reactive protein] levels, serum albumin levels, and serum and fecal infliximab levels,” the researchers added.

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