Intest Res.  2021 Jul;19(3):323-331. 10.5217/ir.2020.00039.

Long-term outcomes of infliximab in a real-world multicenter cohort of patients with acute severe ulcerative colitis

• Oh SJ
• Shin GY
• Soh H
• Lee JG
• Im JP
• Eun CS
• Lee KM
• Park DI
• Han DS
• Kim HJ
• Lee CK

• KMID: 2518688
• DOI: http://doi.org/10.5217/ir.2020.00039

Abstract

Background/Aims
Infliximab (IFX) has proven effective as rescue therapy in steroid-refractory acute severe ulcerative colitis (ASUC), however, the long-term real-world data are scarce. Our study aimed to assess the long-term treatment outcomes of IFX in a real-life cohort.
Methods
We established a multicenter retrospective cohort of hospitalized patients with ASUC, who met Truelove and Witt’s criteria and received intravenous corticosteroid (IVCS) or IFX during index hospitalization between 2006 and 2016 in 5 university hospitals in Korea. The cohort was systematically followed up until colectomy, death or last follow-up visit.
Results
A total of 296 patients were followed up for a mean of 68.9 ± 44.0 months. During index hospitalization, 49 patients were treated with IFX; as rescue therapy for IVCS failure in 37 and as first-line medical therapy for ASUC in 12. All patients treated with IFX avoided colectomy during index hospitalization. The cumulative rates of rehospitalization and colectomy were 20.4% and 6.1% at 3 months and 39.6% and 18.8% at the end of follow-up, respectively. Patients treated with IFX presented with significantly shorter colectomy-free survival than IVCS responders (P= 0.04, log-rank test). Both cytomegalovirus colitis and Clostridioides difficile infection (CDI) were the significant predictors of colectomy in the overall study cohort (hazard ratios of 6.57 and 4.61, respectively). There were no fatalities.
Conclusions
Our real-world cohort study demonstrated that IFX is an effective therapeutic option in Korean patients with ASUC, irrespective of IFX indication. Aggressive vigilance for cytomegalovirus colitis and CDI is warranted for hospitalized patients with ASUC.

Keyword

Colitis, ulcerative; Infliximab; Hospitalization; Colectomy

Figure

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  Fig. 1. Flowchart of the study. aOthers (3 adalimumab, 1 methorexate). ASUC, acute severe ulcerative colitis; IBD, inflammatory bowel disease; IFX, infliximab; IVCS, intravenous corticosteroid; hASUC, hospitalized patients with ASUC.

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  Fig. 2. Comparison of long-term outcomes between the study populations. IVCS, intravenous corticosteroid; IFX, infliximab.

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  Fig. 3. Kaplan-Meier estimation of cumulative colectomy-free survival for the study populations (log-rank test, P=0.036). IVCS, intravenous corticosteroid; IFX, infliximab; IFX rescue, IFX as rescue therapy after failure of IVCS; IFX initial, IFX as first-line therapy for acute severe ulcerative colitis.

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