Rescue Therapy In Ulcerative Colitis Research Articles

Infliximab as Rescue Therapy for Hospitalized Patients With Crohnʼs Disease Failing Intravenous Corticosteroids

Introduction: Infliximab (IFX) has been shown to be effective rescue therapy for ulcerative colitis in hospitalized patients failing intravenous (IV) corticosteroids (CS). However there is little evidence describing its use in similar hospitalized Crohn's Disease (CD) patients. Our aim was to determine if IFX is effective rescue therapy for corticosteroid (CS) resistant CD in hospitalized patients. Methods: All in-patients with CD who received IFX as rescue therapy at Northshore University and Long Island Jewish hospitals from 2007 to 2016 were selected. Records were reviewed for demographics, Montreal classification of CD, pre-admission and inpatient treatment, surgical rates, and 30 and 90-day readmission rates. Only patients failing IV CS prior to IFX were included in the final analysis.Table: Table. Patient DemographicsTable: Table. Dosage of intravenous corticosteroid and infliximab administered during hospitalizationResults: A total of 40 patients received IFX, of which 17 had failed IV CS. Patient demographics are listed in table 1. Mean hospital stay was 9.8 days (range 4 to 30). At admission, 55% were taking oral CS (n=9). Four patients were on outpatient IFX therapy, but still received IV CS during hospitalization prior to IFX. Doses of IV CS and IFX are listed in table 2. The mean duration of IV CS therapy before IFX was 6.9 days (range 4 to 18). Two patients failed IFX and required surgery including a colectomy for pan-colitis with spontaneous perforation, and an ileocolectomy for terminal ileal stricture. Neither patient had received IFX as an outpatient. Of the 15 patients who responded to rescue IFX, the median duration of hospital stay following IFX was 3 days (range 3 to 18 days). Re-admission rates were 29% and 47% at 30 and 90 days respectively, without further surgeries noted. Conclusion: In our series severe CD patients failing IV CS treated with IFX had low rates of urgent surgery and a generally rapid response to treatment, supporting IFX as an effective rescue therapy. By only including those with prior failure of IV CS, we have likely excluded patients for whom IFX was given in the hospital for reasons other than severe disease. Our results suggest that even individuals with severe acute CD flare can be treated with early introduction of IFX, avoiding prolonged CS use and hospitalization. With more biologic therapies becoming available, further trials are needed to assess the efficacy of IFX and newer agents to correctly position rescue therapies for severe CD.

Adjuvant use of antibiotics with corticosteroids in inflammatory bowel disease exacerbations requiring hospitalisation: a retrospective cohort study and meta‐analysis

Patients hospitalised with an exacerbation of inflammatory bowel disease (IBD) often receive antibiotics in addition to intravenous steroids. However, their efficacy in this setting is unclear. To ascertain if the addition of antibiotics to intravenous steroids modifies short and long-term clinical outcomes. Our study included IBD patients hospitalised between 2009 and 2014 who received intravenous (IV) steroids with or without adjuvant antibiotics. Outcomes of interest included length of stay (LOS), need for medical and surgical rescue therapy during the hospitalisation, and at 90 and 365 days. A meta-analysis of previously published randomised trials was additionally performed. A total of 354 patients were included [145 ulcerative colitis (UC); 209 Crohn's disease (CD)]. In CD, combination of IV steroids and antibiotics did not change need for in-hospital medical rescue therapy, surgery or hospitalisations at 1 year but was associated with greater LOS (6.1 vs. 4.6 days, P = 0.02). In UC, patients receiving antibiotics were less likely to require in-hospital medical rescue therapy [odds ratio (OR): 0.42, 95% confidence interval (CI): 0.19-0.93] but experienced no statistically significant differences in LOS, in-hospital surgery, re-hospitalisations or surgery by 1 year. A meta-analysis of three relevant randomised trials demonstrated no difference in clinical improvement with antibiotics over placebo (OR: 1.08, 95% CI: 0.50-2.32). The addition of antibiotics to intravenous steroids for treatment of IBD exacerbations was associated with a reduced need for in-hospital medical rescue therapy in ulcerative colitis without significant long-term benefit, and did not affect short- or long-term outcomes in Crohn's disease.

Current Practice of Anti-TNF-α Treatment in Inflammatory Bowel Disease: Results From A National Survey in Sweden

AIM: To assess current practice of anti-TNF-α treatment in inflammatory bowel disease among Swedish gastroenterologists. Methods: A web-based questionnaire consisting of 26 multiple-choice questions was sent to 272 gastroenterologists in adult practice. Results: Of the 112 gastroenterologists (41%) that responded, all 102 in inflammatory bowel disease practice used anti-TNF-α. Almost all (97%) used combination therapy with immunomodulators and three quarters (73%) used both thiopurines and methotrexate as immunomodulators. The dominant treatment strategy was the “rapid step up” model, favored by 67%. Two thirds continued with combination therapy for more than 6 months and 80% had actively discontinued anti-TNF-α treatment in patients with longstanding remission. Two thirds (61%) had experience of anti-TNF-α during pregnancy and breast-feeding. The dominant strategy, advocated by 91%, was to continue treatment during the first two trimesters, and, if necessary, resume after delivery. All gastroenterologists screened for tuberculosis, 88% for hepatitis B and C, but only 33% vaccinated regularly against varicella zoster and MPR. Discussion: Respondents from university hospitals were more likely to discontinue anti-TNF-α treatment (91% vs 70%, P=0.01), use rapid infliximab infusions (24% vs 7%, P=0.004), and use IGRA testing in tuberculosis screening (88% vs 71%, P=0.04). They were also less likely to use single infliximab infusions as rescue therapy for ulcerative colitis (14% vs 33%, P=0.05). Conclusions: Recent advances in anti-TNF-α treatment of inflammatory bowel disease seem to have been adapted to a large extent by Swedish gastroenterologists. Minor differences in clinical practice were observed between university-based and other gastroenterologists.

The effect of infliximab on patients with ulcerative colitis in Korea.

Background/AimsInfliximab was introduced recently as a rescue therapy for ulcerative colitis (UC) patients refractory to conventional treatments such as therapy with 5-amiono salicylic acids (5-ASA), immune modulators, and corticosteroids. However, there is insufficient data about its efficacy and safety in Korea.MethodsFrom 7 tertiary referral hospitals, 33 patients who were treated with infliximab for moderate to severe (Mayo score 6-12) UC refractory to conventional treatment were recruited to this study. Clinical remission was defined as a total Mayo score of 2 or lower and every subscore less than 2. Partial response was defined as a decrease of Mayo score at least 3 points from baseline.ResultsTwenty-three patients (69.7%) showed clinical remission and 29 patients (87.8%) showed partial response in the observation period. When the remission and non-remission groups were compared in univariate analysis, only a higher total Mayo score at base line (11.0±0.9 vs. 9.9±1.5; P=0.04) was related to remission. The remission maintenance rate decreased with time in the Kaplan-Meier analysis. Two patients experienced re-remission after the first remission followed by aggravation during infliximab treatment. Three patients stopped infliximab treatment owing to adverse events including rhabdomyolysis, pneumonia, and fever of unknown origin.ConclusionsIf there is no choice except surgery for UC patients refractory to conventional treatment, infliximab is an effective and relatively safe treatment option for these patients in Korea.

Infliximab as rescue therapy in hospitalised patients with steroid-refractory acute ulcerative colitis: a long-term follow-up of 211 Swedish patients

Rescue therapy with infliximab (IFX) has been proven effective in a steroid-refractory attack of ulcerative colitis (UC). The long-term efficacy is not well described. To present a retrospective study of IFX as rescue therapy in UC. Primary end points were colectomy-free survival at 3 and 12 months. In this multicentre study, 211 adult patients hospitalised between 1999 and 2010 received IFX 5 mg/kg as rescue therapy due to a steroid-refractory, moderate-to-severe attack of UC. Exclusion criteria were duration of current flare for >12 weeks, corticosteroid treatment for >8 weeks before hospitalisation, previous IFX therapy or Crohn's disease. Probability of colectomy-free survival at 3 months was 0.71 (95% CI, 0.64-0.77), at 12 months 0.64 (95% CI, 0.57-0.70), at 3 years 0.59 (95% CI, 0.52-0.66) and at 5 years 0.53 (95% CI, 0.44-0.61). Steroid-free, clinical remission was achieved in 105/211 (50%) and 112/209 (54%) patients at 3 and 12 months respectively. Of 75 colectomies during the first year, 48 (64%) were carried out during the first 14 days, 13 (17%) on days 15-90 and 14 (19%) between 3 and 12 months. There were three (1.4%) deaths during the first 3 months. Infliximab is an effective rescue treatment, both short- and long-term, in a steroid-refractory attack of UC. Most IFX failures underwent surgery during the first 14 days, which calls for studies on how to optimise induction treatment with IFX. Serious complications, including mortality, were rare.

Infliximab rescue therapy in ulcerative colitis, and the effect on subsequent colectomy rates

Infliximab rescue therapy in ulcerative colitis, and the effect on subsequent colectomy rates

Clinical trial: colectomy after rescue therapy in ulcerative colitis – 3‐year follow‐up of the Swedish‐Danish controlled infliximab study

The long-term efficacy of infliximab as rescue therapy in steroid-refractory ulcerative colitis is not well described. To examine the long-term efficacy of infliximab as a rescue therapy through a 3-year follow-up of a previous placebo-controlled trial of infliximab in acute steroid-refractory ulcerative colitis. In the original study, 45 patients were randomized to a single infusion of infliximab 5 mg/kg or placebo, and at 3 months, 7/24 patients given infliximab were operated vs. 14/21 patients given placebo. Three years or later, patients were asked to participate in a clinical follow-up. Another seven patients underwent colectomy during follow-up: five in the infliximab group and two in the placebo group. After 3 years, a total of 12/24 (50%) patients given infliximab and 16/21 (76%) given placebo (P = 0.012) had a colectomy. None of eight patients in endoscopic remission at 3 months later had a colectomy compared with 7/14 (50%) patients who were not in remission (P=0.02). There was no mortality. The benefit of rescue therapy with infliximab in steroid-refractory acute ulcerative colitis remained after 3 years. The main advantage of infliximab treatment occurred during the first 3 months, whereas subsequent colectomy rates were similar in the two groups. Mucosal healing at 3 months influenced later risk of colectomy.

Infliximab as rescue therapy in ulcerative colitis

Infliximab as rescue therapy in ulcerative colitis