Infliximab Dose Escalation as an Effective Strategy for Managing Secondary Loss of Response in Ulcerative Colitis

被引:24
作者
Taxonera, Carlos [1 ,2 ]
Barreiro-de Acosta, Manuel [3 ]
Calvo, Marta [4 ]
Saro, Cristina [5 ]
Bastida, Guillermo [6 ]
Martin-Arranz, Maria D. [7 ]
Gisbert, Javier P. [8 ,9 ]
Garcia-Sanchez, Valle [10 ,11 ]
Marin-Jimenez, Ignacio [12 ]
Bermejo, Fernando [13 ]
Chaparro, Maria [8 ,9 ]
Ponferrada, Angel [14 ]
Martinez-Montiel, Maria P. [15 ]
Pajares, Ramon [16 ]
de Gracia, Celia [12 ]
Olivares, David [1 ,2 ]
Alba, Cristina [1 ,2 ]
Mendoza, Juan L. [1 ,2 ]
Fernandez-Blanco, Ignacio [17 ]
机构
[1] Hosp Clin San Carlos, Dept Gastroenterol, Inflammatory Bowel Dis Unit, Madrid 28040, Spain
[2] Hosp Clin San Carlos IdISSC, Inst Invest, Madrid 28040, Spain
[3] Hosp Clin Santiago, Dept Gastroenterol, Santiago De Compostela, Spain
[4] Hosp Puerta de Hierro, Dept Gastroenterol, Madrid, Spain
[5] Hosp Cabuenes, Dept Gastroenterol, Gijon, Spain
[6] Hosp La Fe, Dept Gastroenterol, E-46009 Valencia, Spain
[7] Hosp La Paz, Dept Gastroenterol, Madrid, Spain
[8] Hosp Univ La Princesa, Inst Invest Sanitaria Princesa IP, Dept Gastroenterol, Madrid, Spain
[9] CIBEREHD, Madrid, Spain
[10] Univ Cordoba, Hosp Reina Sofia, Dept Gastroenterol, Cordoba, Spain
[11] Univ Cordoba, IMIBIC, Cordoba, Spain
[12] Hosp Gen Gregorio Maranon, Dept Gastroenterol, Madrid, Spain
[13] Hosp Fuenlabrada, Dept Gastroenterol, Madrid, Spain
[14] Hosp Infanta Leonor, Dept Gastroenterol, Madrid, Spain
[15] Hosp 12 Octubre, Dept Gastroenterol, E-28041 Madrid, Spain
[16] Hosp Infanta Sofia, Dept Gastroenterol, Madrid, Spain
[17] Hosp Univ Moncloa, Inflammatory Bowel Dis Unit, Madrid, Spain
关键词
Ulcerative colitis; Infliximab; Dose escalation; Dose optimization; Colectomy; Cohort study; CROHNS-DISEASE PATIENTS; MAINTENANCE THERAPY; INTENSIFICATION; INDUCTION; POLYMORPHISMS; REQUIREMENT; OUTCOMES; DRUG; NEED; IBD;
D O I
10.1007/s10620-015-3735-4
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
The outcomes of infliximab dose escalation in ulcerative colitis (UC) have not been well evaluated. To assess the short- and long-term outcomes of infliximab dose escalation in a cohort of patients with UC. This was a multicenter, retrospective, cohort study. All consecutive UC patients who had lost response to infliximab maintenance infusions and who underwent infliximab dose escalation were included. Post-escalation short-term clinical response and remission were evaluated. In the long term, the cumulative probabilities of infliximab failure-free survival and colectomy-free survival were calculated. Predictors of short-term response and event-free survival were estimated using logistic regression analysis and Cox proportional hazard regression analysis. Seventy-nine patients were included. Fifty-four patients (68.4 %) achieved short-term clinical response and 41 patients (51.9 %) entered in clinical remission. After a median follow-up of 15 months [interquartile range (IQR) 8-26], 33 patients (41.8 %) had infliximab failure. Patients with short-term response had a significantly lower adjusted rate of infliximab failure [hazard ratio (HR) 0.24, 95 % confidence interval (CI) 0.12-0.49; p < 0.001]. During a median follow-up of 24 months (IQR 13-34), 9 patients (11.4 %) needed colectomy. Short-term response was identified as a predictor of colectomy avoidance (HR 0.14; 95 % CI 0.03-0.69; p < 0.007). In UC patients who lost response to infliximab during maintenance, infliximab dose escalation enabled recovery of short-term response in nearly 70 % of patients. In the long term, 58 % of patients maintained sustained clinical benefit, and 9 of 10 avoided colectomy. Short-term response was associated with an 86 % reduction in the relative risk of colectomy.
引用
收藏
页码:3075 / 3084
页数:10
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