Background: The long-term effectiveness of infliximab (IFX) in ulcerative colitis (UC) and predictors of treatment response remain poorly characterized.
Methods: A retrospective cohort study was conducted in 213 consecutive patients with active steroid-refractory or steroid-dependent UC treated with induction and scheduled maintenance IFX at an inflammatory bowel disease referral center. Outcomes included annual steroid-free remission (SFR), IFX failure with discontinuation, colectomy, and serious adverse events.
Results: The 1- and 5-year cumulative probabilities for SFR were 39% and 14%, for IFX failure were 31.7% and 55.6%, and for colectomy were 19.2% and 37.4%, respectively. A sensitivity analysis considering the last clinical observation in patients with incomplete follow-up demonstrated a long-term SFR rate of 36%. Among responders to IFX induction therapy, achieving clinical remission before maintenance IFX therapy predicted SFR at 1 year (adjusted odds ratio = 4.50; 95% CI, 1.75–11.53), whereas the need for IFX dose intensification during the first year of therapy predicted a lower odds of SFR at 1 year (adjusted odds ratio = 0.28; 95% CI, 0.11–0.67) and a greater hazard of IFX failure beyond 1 year (adjusted hazard ratio = 2.57; 95% CI, 1.14–5.81). Older age and shorter UC duration at IFX initiation predicted poorer long-term outcomes.
Conclusions: In patients with moderate-to-severe UC treated with scheduled IFX at an inflammatory bowel disease center, close to half of the patients are still on IFX at 5 years, although a smaller proportion of patients achieve long-term SFR. The magnitude and stability of early response to IFX is associated with long-term therapeutic benefit to this agent.
Article first published online 19 June 2015.
*The Ottawa Hospital IBD Centre, Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada; and
†Mount Sinai Hospital IBD Centre, Department of Medicine, University of Toronto and Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada.
Reprints: Sanjay K. Murthy, MD, MSc, FRCPC, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON, Canada, K1H 8L6 (e-mail: email@example.com).
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S. K. Murthy has participated in advisory boards and educational programs for AbbVie. A. H. Steinhart has participated in advisory boards and invited lectures for Janssen, AbbVie, and Takeda and has received grant support from AbbVie. M. S. Silverberg has participated in advisory boards and invited lectures from Janssen, AbbVie, and Takeda and has received consulting fees from Janssen and Takeda and research support from AbbVie. G. R. Greenberg has participated in advisory boards and invited lectures for Janssen, AbbVie, and Takeda. K. Croitoru has participated in advisory boards for Janssen, AbbVie, and Takeda and has received educational grants from Jansen and AbbVie. G. C. Nguyen has participated in advisory boards for Janssen and AbbVie.
M. S. Silverberg and A. H. Steinhart are co-senior authors on the study.
Received April 03, 2015
Accepted April 14, 2015