Efficacy of anti-tumor necrosis factor therapy in patients with ulcerative colitis.

Abstract

OBJECTIVES:

Tumor necrosis factor-alpha (TNF-alpha) is an important cytokine involved in the pathogenesis of inflammatory bowel disease. The monoclonal antibody to TNF-alpha, infliximab, is effective in treating Crohn's disease. Preclinical studies suggest the importance of TNF-alpha in treating ulcerative colitis (UC). We report the effectiveness of infliximab for UC and examine factors predictive of response to medication.

METHODS:

Data from all UC patients receiving infliximab at four institutions were analyzed. Disease activity was determined by the Disease Activity Index.

RESULTS:

A total of 27 patients with active UC received inpatient (37%) and outpatient (63%) infliximab as single (52%) or multiple (two to 15) infusions (48%). Twelve patients (44%) achieved remission and six patients (22%) had partial response. Nine patients had no response; five subsequently underwent total colectomy. The median time to achieve response and remission was 4 days and the median duration 8 wk. Nine of the 18 patients who responded experienced 19 relapses; 18 of these relapses (95%) were successfully treated with repeat infusions. Steroid-refractory patients were less likely to respond to infliximab therapy than were steroid-responsive patients (33% vs 83%; p = 0.026). No other factors were predictive of response to infliximab. Two patients developed serious adverse events, including death in one case.

CONCLUSIONS:

Preliminary evidence suggest effectiveness of infliximab in the treatment of UC, including medically refractory severe disease. Individuals who are refractory to corticosteroids, however, may be unlikely to respond to infliximab. A randomized controlled trial is necessary to further investigate the efficacy of infliximab in patients with UC.

• Authors: Chinyu Su, Bruce A Salzberg, James D Lewis, Julius J Deren, Asher Kornbluth, David A Katzka, Robert B Stein, Douglas R Adler, Gary R Lichtenstein
• Journal: The American journal of gastroenterology (Am J Gastroenterol) Vol. 97 Issue 10 Pg. 2577-84 (Oct 2002) ISSN: 0002-9270 [Print] United States
• PMID: 12385442 (Publication Type: Journal Article)

Chemical References

• Antibodies, Monoclonal
• Tumor Necrosis Factor-alpha
• Infliximab

Topics

• Adult
• Aged
• Antibodies, Monoclonal (adverse effects, therapeutic use)
• Colitis, Ulcerative (drug therapy)
• Female
• Humans
• Infliximab
• Male
• Middle Aged
• Remission Induction
• Treatment Outcome
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)