Abstract
BackgroundEfficacy of tumor necrosis factor alpha (TNF-α) blockers for treatment of ulcerative colitis that is unresponsive to conventional therapy is unclear due to recent studies yielding conflicting results.AimTo assess the efficacy and safety of anti-TNF-α agents for treatment of ulcerative colitis patients who were intolerant or refractory to conventional medical therapy.MethodsPubmed, Embase, and the Cochrane database were searched. Analysis was performed on randomized controlled trials that assessed anti-TNF-α therapy on ulcerative colitis patients that had previously failed therapy with corticosteroids and/or immunosuppressants. The primary outcome focused on was the frequency of patients that achieved clinical remission. Further trial outcomes of interest included rates of remission without patient use of corticosteroids during the trial, extent of mucosal healing, and the number of cases that resulted in colectomy and serious side effects.ResultsEight trials from seven studies (n = 2122) met the inclusion criteria and were thus included during analysis. TNF-α blockers demonstrated clinical benefit as compared to placebo control as evidenced by an increased frequency of clinical remission (p<0.00001), steroid-free remission (p = 0.01), endoscopic remission (p<0.00001) and a decrease in frequency of colectomy (p = 0.03). No difference was found concerning serious side effects (p = 0.05). Three small trials (n = 57) comparing infliximab to corticosteroid treatment, showed no difference in frequency of clinical remission (p = 0.93), mucosal healing (p = 0.80), and requirement for a colectomy (p = 0.49). One trial compared infliximab to cyclosporine (n = 115), wherein no difference was found in terms of mucosal healing (p = 0.85), colectomy frequency (p = 0.60) and serious side effects (p = 0.23).ConclusionTNF-α blockers are effective and safe therapies for the induction and maintenance of long-term remission and prevention of treatment by colectomy for patients with refractory ulcerative colitis where conventional treatment was previously ineffective. Furthermore, infliximab and cyclosporine were found to be comparable for treating acute severe steroid-refractory ulcerative colitis.
Highlights
Ulcerative colitis (UC) is a chronic disease characterized by diffuse mucosal inflammation within the colon, often with alternating periods of exacerbation and remission
Infliximab and cyclosporine were found to be comparable for treating acute severe steroid-refractory ulcerative colitis
Search strategy The databases Pubmed, Cochrane Library and Embase were searched for studies published between 1991 and July 20, 2013 containing the terms ‘‘(infliximab or adalimumab or certolizumab or golimumab or tumor necrosis factor alpha) and and.’’ the reference lists of any studies previously identified as having met the inclusion criteria were manually reviewed to find additional relevant publications
Summary
Ulcerative colitis (UC) is a chronic disease characterized by diffuse mucosal inflammation within the colon, often with alternating periods of exacerbation and remission This disease has conventionally been treated with 5-aminosalicylic acid, corticosteroids and oral immunosuppressant (e.g. azathioprine, 6-mercaptopurine) with the goals of achieving clinical or mucosal remission, and/or eliminating long-term corticosteroid use [1]. These conventional therapies are in many instances ineffective or cannot be tolerated by the patients. Efficacy of tumor necrosis factor alpha (TNF-a) blockers for treatment of ulcerative colitis that is unresponsive to conventional therapy is unclear due to recent studies yielding conflicting results
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
