Tumor necrosis factor-alpha (TNF-alpha) is involved in the pathogenesis of inflammatory bowel disease, while the monoclonal antibody to TNF-alpha, infliximab, is effective in treating Crohn's disease.
Preclinical studies have suggested that TNF-alpha may be important in treating ulcerative colitis (UC).
In this study, a team of researchers from the USA investigated the effectiveness of infliximab for UC and examined factors predictive of response to medication.
The team analyzed data from all UC patients receiving infliximab, at four institutions.
|Steroid-refractory patients less likely to respond to infliximab therapy.|
|American Journal of Gastroenterology|
A total of 27 patients with active UC received inpatient (37%) and outpatient (63%) infliximab as single (52%) or multiple (two to 15) infusions (48%).
The team determined disease activity by the Disease Activity Index.
The research team found that 44% of patients achieved remission and 22% had partial response.
There were 9 patients identified who had no response to the treatment, 5 subsequently underwent total colectomy.
The team found the median time to achieve response and remission as 4 days, with the median duration of this being 8 weeks.
Furthermore, 9 of the 18 patients who responded to the treatment experienced relapses, 95% of these relapses were successfully treated with repeat infusions.
Steroid-refractory patients were less likely to respond to infliximab therapy than were steroid-responsive patients (33% versus 83%).
The team did not identify any other factors that were predictive of response to infliximab.
Throughout the study, 2 patients developed serious adverse events, including death in 1 case.
Dr Chinyu Su's team concluded, "Preliminary evidence suggest effectiveness of infliximab in the treatment of UC, including medically refractory severe disease".
"Individuals who are refractory to corticosteroids, however, may be unlikely to respond to infliximab.
"A randomized controlled trial is necessary to further investigate the efficacy of infliximab in patients with UC".