Early predictors of colectomy and long‐term maintenance of remission in ulcerative colitis patients treated using anti‐tumour necrosis factor therapy. Issue 5 (May 2014)

• Record Type: Journal Article
• Authors: Subramaniam, K.; Richardson, A.; Dodd, J.; Platten, J.; Shadbolt, B.; Pavli, P.
• Is Part Of: Internal medicine journal. Volume 44:Issue 5(2014)
• Page Start: 464
• Page End: 470
• Publication Date: 2014-05
• Subjects: Medicine -- Periodicals; 616
• DOI: 10.1111/imj.12397
• Languages: English
• ISSNs: 1444-0903

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="imj12397-sec-0001" sec-type="section"> <title>Background</title> <p>Anti‐tumour necrosis factor (TNF) agents are used as induction and maintenance therapy in ulcerative colitis (UC) refractory to standard therapy and as rescue therapy in acute severe UC (ASUC).</p> </sec> <sec id="imj12397-sec-0002" sec-type="section"> <title>Aims</title> <p>To determine long‐term outcomes including colectomy rates, predictors of maintenance of response and remission, risk of serious adverse events by reviewing 12‐year clinical experience from a single centre in Australia.</p> </sec> <sec id="imj12397-sec-0003" sec-type="section"> <title>Methods</title> <p>Seventy‐one patients with moderate‐severe UC (Mayo score ≥6) (<italic>n</italic> = 52) and ASUC (<italic>n</italic> = 19) treated with anti‐TNF agents were included. Primary end‐points were colectomy at 12 weeks and colectomy‐free survival at last follow up. Secondary endpoints included clinical response (decrease in Mayo score of ≥3) and remission (Mayo score ≤2).</p> </sec> <sec id="imj12397-sec-0004" sec-type="section"> <title>Results</title> <p>Colectomy at 12 weeks was 1%, and colectomy‐free survival was 69%. Using full Mayo score, at 3 months, 32/37 (87%) refractory and 9/12 (75%) ASUC patients responded to anti‐TNF therapy; 19/37 (51%) refractory and 8/12 (67%) ASUC patients were in remission. Long‐term response rates (mean follow up 37.4 months) were 24/44 (55%) and 11/15 (73%) in refractory and ASUC groups respectively. Long‐term remission rates were 43% in refractory and 60% in ASUC patients. Twenty two of 71 (31%) underwent colectomy (mean time 50.4 months). Clinical non‐response at 3 months was a predictor of colectomy (hazard ratio = 9.346; <italic>P</italic> = 0.001). ASUC predicted long‐term maintenance of response (odds ratio 19.4; <italic>P</italic> = 0.013) and remission (odds ratio 6.13; <italic>P</italic> = 0.037). Two of 71 patients had serious infections.</p> </sec> <sec id="imj12397-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Anti‐TNF therapy is effective in both refractory and ASUC. We argue that early anti‐TNF therapy may improve outcome in UC.</p> </sec> </abstract>