About 40% of patients with acute severe ulcerative colitis will not respond to intravenous corticosteroids.
These patients require second-line medical therapy or colectomy.
A recent controlled trial has suggested that infliximab may be effective as rescue therapy.
|66% responded, avoiding colectomy during admission|
|Alimentary Pharmacology & Therapeutics|
Dr Lees and colleagues from Scotland assessed the value of infliximab as rescue therapy for acute severe colitis in a retrospective cohort of ulcerative colitis patients.
The team found that all patients satisfied Truelove and Witts criteria on admission, and failed to respond to intravenous corticosteroids.
The patients received infliximab 5 mg/kg as rescue therapy.
Response was defined as need for colectomy at hospital discharge and by 90 days.
The researcher assessed a total of 39 patients, with a median age of 32 years.
The team found that 66% of patients responded, avoiding colectomy during the acute admission.
The patients were followed up for a median of 203 days.
The team noted that hypoalbuminemia was a consistent predictor of non-response on univariate and multivariate analysis.
At day 3 of intravenous steroids, 50% with serum albumin less than 34 g/L had urgent colectomy vs 8% with a serum albumin of 34 g/L.
The research team observed 2 serious adverse events, including 1 death due to Pseudomonas pneumonia, and 1 post-operative fungal septicemia.
Dr Lees' team concluded, "Infliximab represents a moderately effective rescue therapy for patients with acute severe ulcerative colitis."
"Serious adverse events, including death, do occur and should be discussed with patients prior to therapy."