Real-life outcome of anti-tumor necrosis factor α in the ambulatory treatment of ulcerative colitis

AIM: To evaluate the outcome of anti-tumor necrosis factor alpha (anti-TNF alpha) therapy in outpatients with ulcerative colitis at a tertiary referral center. METHODS: All patients with a confirmed diagnosis of ulcerative colitis undergoing therapy with infliximab and/or adalimumab at the outpatient clinic for inflammatory bowel diseases at the University Hospital Heidelberg between January 2011 and February 2014 were retrospectively enrolled. Patients with a follow-up period of less than 6 mo from start of anti-TNF alpha therapy were excluded. Medical records of all eligible individuals were carefully reviewed. Steroid-free clinical remission of a duration of at least 3 mo, colectomy rate, duration of anti-TNF alpha therapy, need for anti-TNF alpha dose escalation, and the occurrence of adverse events were evaluated as the main outcome parameters. RESULTS: Seventy-two patients were included (35 treated with infliximab, 17 with adalimumab, 20 with both consecutively). Median follow-up was 27 mo (range: 6-87 mo). Steroid-free clinical remission was achieved by 22.2% of the patients (median duration: 21 mo until end of follow-up; range: 3-66 mo). Patients attaining steroid-free clinical remission displayed lower hemoglobin and albumin blood levels at the start of treatment than those who did not achieve remission. The overall colectomy rate was 20.8%. Nearly 50% of the patients underwent anti-TNF alpha dose escalation during the follow-up period. For both the infliximab and the adalimumab treated patients, non-response to anti-TNF alpha therapy was the major reason for treatment discontinuation. 18.2% of the infliximab-treated patients and 13.5% of the adalimumab-treated patients had to discontinue their therapy due to adverse events. CONCLUSION: Real-life remission rates of ulcerative colitis under anti-TNF alpha are overall low, but some patients have a clear long-term benefit.