Infliximab: rescue therapy in severe UC▸

The Th1/Th2 hypothesis to explain the pattern of cytokine activation in Crohn’s and ulcerative colitis (UC) predicted that anti-tumour necrosis factor therapy would not be useful in UC. However, a number of cases of refractory colitis responding well to infliximab encouraged randomised trials in UC, and this Swedish study evaluated infliximab in hospitalised patients with severe UC. Patients were recruited if they scored eight or more on the SEO activity index at day 3 of standard intravenous corticosteroid therapy (indicating a 72% chance of colectomy) or if they had a Seo index indicating severe or moderately severe disease between days 5 and 7. Patients were randomised to a single infusion of infliximab 5 mg/kg or placebo, and corticosteroid therapy continued. Although the trial was stopped early because of slow recruitment, 45 patients were randomised. The primary end point was colectomy rate at three months, and this was …