Monica Cesarini1, Konstantinos Katsanos2, Konstantinos Papamichael3, Pierre Ellul4, Peter L Lakatos5, Flavio Caprioli6, Uri Kopylov7, Epameinondas Tsianos2, Gerassimos J Mantzaris3, Shomron Ben-Horin7, Silvio Danese8, Gionata Fiorino9. 1. Internal Medicine and Medical Specialties, Sapienza, University of Rome, Rome, Italy. 2. Internal Medicine and Hepato-Gastroenterology, University of Ioannina, Ioannina, Greece. 3. 1st Department of Gastroenterology, Evangelismos Hospital, Athens, Greece. 4. Mater Dei Hospital, Tal Qroqq, Malta. 5. 1st Department of Medicine, Semmelweis University, Budapest, Hungary. 6. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Gastroenterology Unit 2, IRCCS Ca' Granda Foundation - Ospedale Maggiore Policlinico, Milan, Italy. 7. Gastroenterology Department, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 8. IBD Center, IRCCS Humanitas, Rozzano, Milan, Italy. 9. IBD Center, IRCCS Humanitas, Rozzano, Milan, Italy. Electronic address: gionataf@gmail.com.
Abstract
BACKGROUND: Subjects maintained on infliximab scheduled therapy for inflammatory bowel disease may require dose optimization due to secondary loss of response. There are limited data on infliximab dose optimization for ulcerative colitis. AIMS: To investigate dose optimization in ulcerative colitis patients with secondary loss of response. METHODS: This was a retrospective multicentre study. Primary outcome was rapid clinical response assessed at the next administration of infliximab after dose intensification. Secondary outcomes were rapid clinical remission, and clinical response, remission and colectomy rate by week 52. Doubling the dose (10mg/kg q8 weeks) vs. shortening the dose interval (5mg/kg every 6 or 4 weeks) were compared. RESULTS: Forty-one patients from eight centres were enrolled (15 for double dose and 26 for interval shortening). Rapid response was achieved in 37/41 patients (90.2%), while 19/41 (46.3%) achieved rapid clinical remission. At week 52, 28/41 patients were maintained in clinical remission, but 4 (9.8%) underwent colectomy. No difference was found between the two optimization strategies. Subjects achieving rapid clinical response had a significantly higher colectomy-free rate at week 52 (p=0.002). CONCLUSION: Dose optimization of infliximab was effective to restore clinical response or remission and to prevent colectomy in ulcerative colitis patients with secondary loss of response.
BACKGROUND: Subjects maintained on infliximab scheduled therapy for inflammatory bowel disease may require dose optimization due to secondary loss of response. There are limited data on infliximab dose optimization for ulcerative colitis. AIMS: To investigate dose optimization in ulcerative colitispatients with secondary loss of response. METHODS: This was a retrospective multicentre study. Primary outcome was rapid clinical response assessed at the next administration of infliximab after dose intensification. Secondary outcomes were rapid clinical remission, and clinical response, remission and colectomy rate by week 52. Doubling the dose (10mg/kg q8 weeks) vs. shortening the dose interval (5mg/kg every 6 or 4 weeks) were compared. RESULTS: Forty-one patients from eight centres were enrolled (15 for double dose and 26 for interval shortening). Rapid response was achieved in 37/41 patients (90.2%), while 19/41 (46.3%) achieved rapid clinical remission. At week 52, 28/41 patients were maintained in clinical remission, but 4 (9.8%) underwent colectomy. No difference was found between the two optimization strategies. Subjects achieving rapid clinical response had a significantly higher colectomy-free rate at week 52 (p=0.002). CONCLUSION: Dose optimization of infliximab was effective to restore clinical response or remission and to prevent colectomy in ulcerative colitispatients with secondary loss of response.
Authors: Carlos Taxonera; Manuel Barreiro-de Acosta; Marta Calvo; Cristina Saro; Guillermo Bastida; María D Martín-Arranz; Javier P Gisbert; Valle García-Sánchez; Ignacio Marín-Jiménez; Fernando Bermejo; María Chaparro; Ángel Ponferrada; María P Martínez-Montiel; Ramón Pajares; Celia de Gracia; David Olivares; Cristina Alba; Juan L Mendoza; Ignacio Fernández-Blanco Journal: Dig Dis Sci Date: 2015-06-05 Impact factor: 3.199