Introduction Acute severe colitis affects up to 19% of patients with ulcerative colitis (UC) and around 30% of these patients are resistant to intensive steroid therapy and therefore require rescue therapy to prevent emergency colectomy. Although surgery is considered to be potentially curative, restorative proctocolectomy is generally associated with a poorer quality of life than those who respond to medical therapy and thus avoid surgery. UK guidelines recommend that infliximab is only considered as an option for the treatment of acute severe UC in patients in whom ciclosporin is inappropriate. This study evaluates the long term outcomes of UC patients receiving infliximab for rescue therapy at a single centre.
Method We carried out a retrospective review of inpatients with steroid-refractory UC who were treated with infliximab as rescue therapy at University Hospital Birmingham between 2007 and 2014. Data collated included demographics, parameters including endoscopic assessment and operative details if applicable. IV steroid refractory UC patients who failed infliximab rescue therapy and underwent emergency colectomy were compared with those who were successfully rescued. Statistical analyses for categorical variables were assessed using a Fisher’s Exact Probability Test and continuous data were performed using a two-sample t-test assuming unequal variances.
Results A total of 29 steroid refractory acute UC patients received infliximab rescue therapy with a mean follow up period was 2.5 years (range 1–7 years). 6 (21%) patients failed to respond to the rescue therapy and proceeded to emergency colectomy. Patients who underwent an emergency colectomy had a significantly lower albumin (mean 27 g/l vs 35 g/l; p < 0.005), haemoglobin (93 g/l vs 120 g/l; p < 0.005) and received IV steroids for a significantly longer period of time (mean 5 days vs 7 days; p < 0.05). There was no difference in age, duration and extent of UC, endoscopic assessment of severity, WCC and CRP between the two groups. From those that were successfully rescued only 1 patient required a colectomy within 3 months and 3 patients after 1 year. Analysis of a further separate cohort of 7 UC patients who directly had infliximab as were refractory to oral steroids, demonstrated that none of them required an emergency colectomy, while 2 patients had a colectomy within 6 months and 1 patient after 1 year.
Conclusion In patients with acute severe UC infliximab rescue therapy is effective in avoiding colectomy and maintaining remission however delaying its administration beyond 5 days of IV steroids is associated with a significantly higher risk of its failure and progression to emergency colectomy.
Disclosure of interest None Declared.