Examining maintenance care following infliximab salvage therapy for acute severe ulcerative colitis

Abstract

BACKGROUND AND AIMS: Data supporting the optimal maintenance drug therapy & strategy to monitor ongoing response following successful infliximab (IFX) induction, for acute severe ulcerative colitis (ASUC), are limited. We aimed to evaluate maintenance & monitoring strategies employed in patients post IFX induction therapy. METHODS: Patients in 6 Australian tertiary centres treated with IFX for steroid-refractory ASUC between April 2014 & May 2015 were identified via hospital IBD & pharmacy databases. Patients were followed-up for 1 year with clinical data over 12 months recorded. Analysis was limited to patient outcomes beyond 3 months. RESULTS: 41 patients were identified. 5/41 (12%) patients underwent colectomy within 3 months and 1 patient was lost to follow-up. 6/35 (17%) of the remaining patients progressed to colectomy by 12 months. MAINTENANCE THERAPY: Patients maintained on thiopurine monotherapy (14/35) vs. IFX/thiopurine therapy (15/35) were followed up. 2/15 (13%) patients who received combination maintenance therapy underwent a colectomy at 12 months, compared with 1/14 (7%) patients receiving thiopurine monotherapy (p=0.610). MONITORING DURING MAINTENANCE: Post-discharge, thiopurine metabolites were monitored in 15/27 (56%); faecal calprotectin in 11/32 (34%); & serum IFX levels in 4/20 (20%). 20/32 (63%) patients had an endoscopic evaluation after IFX salvage with median time to 1st endoscopy of 109 days (IQR 113-230). CONCLUSION: Following IFX induction therapy for ASUC, the uptake of maintenance therapy in this cohort & strategies to monitor ongoing response were variable. These data suggest that the optimal maintenance & monitoring strategy post IFX salvage therapy remains to be defined.