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Open Access Research article

Long-term efficacy of infliximab for refractory ulcerative colitis: results from a single center experience

Satoshi Yamada1, Takuya Yoshino1, Minoru Matsuura1, Naoki Minami1, Takahiko Toyonaga2, Yusuke Honzawa1, Yoshihisa Tsuji1 and Hiroshi Nakase1*

Author Affiliations

1 Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan

2 The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan

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BMC Gastroenterology 2014, 14:80  doi:10.1186/1471-230X-14-80

Published: 23 April 2014

Abstract

Background

The long-term efficacy of infliximab (IFX) for patients with refractory ulcerative colitis (UC) is unclear. The aim of this study was to assess the long-term outcomes of IFX treatment in patients with refractory UC.

Methods

Thirty-three patients with refractory UC who received IFX treatment at Kyoto University Hospital between 2003 and 2013 were retrospectively evaluated. IFX intensification was defined as a dose escalation (up to 10 mg/kg) and/or shorter intervals between infusions (every 4–6 weeks).

Results

Of the 33 patients who received scheduled infusions of IFX, 24 (72.7%) achieved clinical remission within 8 weeks after initiating IFX treatment. Of these 24 responders, 17 (70.8%) experienced a relapse of UC and required IFX intensification, and 16 (66.7%) eventually maintained clinical remission with IFX treatment, including IFX intensification. Of the 33 patients, 6 (18.2%) underwent colectomy during IFX treatment. Multivariate regression analysis showed that a serum C-reactive protein (CRP) concentration <5 mg/L two weeks after starting IFX was a predictor of a positive clinical response to IFX induction therapy. No severe adverse events occurred in UC patients treated with IFX.

Conclusion

IFX intensification was necessary for long-term maintenance of remission and to prevent colectomy in patients with refractory UC.

Keywords:
Ulcerative colitis; Infliximab; Immunomodulator; Infliximab intensification