Dean Seah1, Matthew C Choy1,2,3, Alexandra Gorelik4, William R Connell2, Miles P Sparrow5,6, Daniel Van Langenberg7,6, Geoffrey Hebbard8, Gregory Moore9,6, Peter De Cruz1,3. 1. Department of Gastroenterology, Austin Health, Melbourne, Australia. 2. Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Australia. 3. Department of Medicine, Austin Academic Centre, University of Melbourne, Melbourne, Australia. 4. Melbourne EpiCentre, Melbourne Health, Melbourne, Australia. 5. Department of Gastroenterology, Alfred Health, Melbourne, Australia. 6. Department of Medicine, Monash University, Melbourne, Australia. 7. Department of Gastroenterology, Eastern Health, Melbourne, Australia. 8. Department of Gastroenterology, Melbourne Health, Melbourne, Australia. 9. Department of Gastroenterology, Monash Health, Melbourne, Australia.
Abstract
BACKGROUND AND AIM: Data supporting the optimal maintenance drug therapy and strategy to monitor ongoing response following successful infliximab (IFX) induction, for acute severe ulcerative colitis (ASUC), are limited. We aimed to evaluate maintenance and monitoring strategies employed in patients post-IFX induction therapy. METHODS: Patients in six Australian tertiary centers treated with IFX for steroid-refractory ASUC between April 2014 and May 2015 were identified via hospital IBD and pharmacy databases. Patients were followed up for 1 year with clinical data over 12 months recorded. Analysis was limited to patient outcomes beyond 3 months. RESULTS: Forty one patients were identified. Five of the 41 (12%) patients underwent colectomy within 3 months, and one patient was lost to follow-up. Six of 35 (17%) of the remaining patients progressed to colectomy by 12 months. Maintenance therapy: Patients maintained on thiopurine monotherapy (14/35) versus IFX/thiopurine therapy (15/35) were followed up. Two of 15 (13%) patients who received combination maintenance therapy underwent a colectomy at 12 months, compared with 1/14 (7%) patients receiving thiopurine monotherapy (P = 0.610). Monitoring during maintenance: Post-discharge, thiopurine metabolites were monitored in 15/27 (56%); fecal calprotectin in 11/32 (34%); and serum IFX levels in 4/20 (20%). Twenty of 32 (63%) patients had an endoscopic evaluation after IFX salvage with median time to first endoscopy of 109 days (interquartile range 113-230). CONCLUSION: Following IFX induction therapy for ASUC, the uptake of maintenance therapy in this cohort and strategies to monitor ongoing response were variable. These data suggest that the optimal maintenance and monitoring strategy post-IFX salvage therapy remains to be defined.
BACKGROUND AND AIM: Data supporting the optimal maintenance drug therapy and strategy to monitor ongoing response following successful infliximab (IFX) induction, for acute severe ulcerative colitis (ASUC), are limited. We aimed to evaluate maintenance and monitoring strategies employed in patients post-IFX induction therapy. METHODS:Patients in six Australian tertiary centers treated with IFX for steroid-refractory ASUC between April 2014 and May 2015 were identified via hospital IBD and pharmacy databases. Patients were followed up for 1 year with clinical data over 12 months recorded. Analysis was limited to patient outcomes beyond 3 months. RESULTS: Forty one patients were identified. Five of the 41 (12%) patients underwent colectomy within 3 months, and one patient was lost to follow-up. Six of 35 (17%) of the remaining patients progressed to colectomy by 12 months. Maintenance therapy: Patients maintained on thiopurine monotherapy (14/35) versus IFX/thiopurine therapy (15/35) were followed up. Two of 15 (13%) patients who received combination maintenance therapy underwent a colectomy at 12 months, compared with 1/14 (7%) patients receiving thiopurine monotherapy (P = 0.610). Monitoring during maintenance: Post-discharge, thiopurine metabolites were monitored in 15/27 (56%); fecal calprotectin in 11/32 (34%); and serum IFX levels in 4/20 (20%). Twenty of 32 (63%) patients had an endoscopic evaluation after IFX salvage with median time to first endoscopy of 109 days (interquartile range 113-230). CONCLUSION: Following IFX induction therapy for ASUC, the uptake of maintenance therapy in this cohort and strategies to monitor ongoing response were variable. These data suggest that the optimal maintenance and monitoring strategy post-IFX salvage therapy remains to be defined.
Authors: Matthew C Choy; Dean Seah; David M Faleck; Shailja C Shah; Che-Yung Chao; Yoon-Kyo An; Graham Radford-Smith; Talat Bessissow; Marla C Dubinsky; Alexander C Ford; Leonid Churilov; Neville D Yeomans; Peter P De Cruz Journal: Inflamm Bowel Dis Date: 2019-06-18 Impact factor: 5.325
Authors: Shin Ju Oh; Ga Young Shin; Hosim Soh; Jae Gon Lee; Jong Pil Im; Chang Soo Eun; Kang-Moon Lee; Dong Il Park; Dong Soo Han; Hyo Jong Kim; Chang Kyun Lee Journal: Intest Res Date: 2020-08-18