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Infliximab Dose Escalation as an Effective Strategy for Managing Secondary Loss of Response in Ulcerative Colitis

Fecha de publicación:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Taxonera C
  • Barreiro-de Acosta M
  • Calvo M
  • Saro C
  • Martín-Arranz MD
  • Gisbert JP
  • García-Sánchez V
  • Marín-Jiménez I
  • Bermejo F
  • Chaparro M
  • Ponferrada Á
  • Martínez-Montiel MP
  • Pajares R
  • de Gracia C
  • Olivares D
  • Alba C
  • Mendoza JL
  • Fernández-Blanco I

Grupos

Abstract

The outcomes of infliximab dose escalation in ulcerative colitis (UC) have not been well evaluated. To assess the short- and long-term outcomes of infliximab dose escalation in a cohort of patients with UC. This was a multicenter, retrospective, cohort study. All consecutive UC patients who had lost response to infliximab maintenance infusions and who underwent infliximab dose escalation were included. Post-escalation short-term clinical response and remission were evaluated. In the long term, the cumulative probabilities of infliximab failure-free survival and colectomy-free survival were calculated. Predictors of short-term response and event-free survival were estimated using logistic regression analysis and Cox proportional hazard regression analysis. Seventy-nine patients were included. Fifty-four patients (68.4 %) achieved short-term clinical response and 41 patients (51.9 %) entered in clinical remission. After a median follow-up of 15 months [interquartile range (IQR) 8-26], 33 patients (41.8 %) had infliximab failure. Patients with short-term response had a significantly lower adjusted rate of infliximab failure [hazard ratio (HR) 0.24, 95 % confidence interval (CI) 0.12-0.49; p < 0.001]. During a median follow-up of 24 months (IQR 13-34), 9 patients (11.4 %) needed colectomy. Short-term response was identified as a predictor of colectomy avoidance (HR 0.14; 95 % CI 0.03-0.69; p < 0.007). In UC patients who lost response to infliximab during maintenance, infliximab dose escalation enabled recovery of short-term response in nearly 70 % of patients. In the long term, 58 % of patients maintained sustained clinical benefit, and 9 of 10 avoided colectomy. Short-term response was associated with an 86 % reduction in the relative risk of colectomy.

Datos de la publicación

ISSN/ISSNe:
0163-2116, 1573-2568

DIGESTIVE DISEASES AND SCIENCES  SPRINGER

Tipo:
Article
Páginas:
3075-3084
PubMed:
26044830
Factor de Impacto:
1,042 SCImago ℠
Cuartil:
Q2 SCImago ℠

Citas Recibidas en Web of Science: 27

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Keywords

  • Ulcerative colitis; Infliximab; Dose escalation; Dose optimization; Colectomy; Cohort study

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