Letter: infliximab in severe ulcerative colitis – is it useful for all patients? Authors’ reply

Abstract

We would like to thank Dr Barreiro-de Acosta and Dr Gisbert for their positive comments1 regarding our study on infliximab as rescue therapy in a steroid-refractory, severe attack of ulcerative colitis (UC).2 Whether patients receiving infliximab can avoid a colectomy, not only in the short- but also in the long-term, is an important issue, and our data are promising in this respect. The probability of colectomy-free survival at 12 months was 0.64 (95% CI 0.57–0.70) and at 5 years, 0.53 (95% CI 0.44–0.61). Furthermore, a steroid-free, clinical remission was achieved at 12 months in the majority of patients escaping a colectomy. The question, raised by Dr Barreiro-de Acosta and Dr Gisbert, whether infliximab is useful and safe for all patients is clinically very relevant. Advanced age has been associated with increased risk of severe infections and mortality after anti-tumour necrosis factor therapy in inflammatory bowel disease.3-5 Our data do not provide a definite answer on safety in older patients, as the study was not designed for such an analysis and the number of patients >65 years of age was small (n = 6). Although the overall mortality within 3 months was low (1.4%), it must be pointed out that two of three deaths occurred in this age group. However, it must be emphasised that we did not assess the contribution of severity of bowel disease and concomitant therapy such as corticosteroids to the lethal outcome in these patients. Increased age and comorbidity are also associated with a higher risk for post-operative complications after a colectomy.6, 7 Altogether, this underscores the need for specific therapeutic guidelines for elderly patients with a severe attack of UC. The authors’ declarations of personal and financial interests are unchanged from those in the original article.2