Predictors of infliximab efficacy in patients with severe attack of ulcerative colitis

Abstract

Aim of investigation. Biological therapy by monoclonal antibodies against tumor necrosis factor (infliximab) allows to avoid colectomy at steroid-resistant severe attack of ulcerative colitis. High cost of such treatment and risk of adverse events related to it requires definition of strict indications for application of this drug. It was necessary to detect factors due to which at early stage of biological therapy it is possible to decide whether infliximab will allow to achieve long-term clinical remission, and also to avoid operative treatment.

Material and methods. The retrospective analysis of biological therapy results in 30 patients with severe steroid-resistant attack of ulcerative colitis, assessed by Truelove and Witts’ criteria was carried out.

Results. Colectomy due to inefficiency of infliximab was executed in 11 patients (36,7%). In groups of the patients, who undergone surgery and those, who avoided resection of the large intestine, various clinical, laboratory and endoscopic parameters were compared. By results of logistic regression predictors of infliximab inefficiency were determined: presence of extensive ulcerative mucosal defects of the colon prior to the beginning of biological therapy (accuracy of colectomy prognosis 78%) and absence of clinical remission at the third injection of the drug (accuracy of colectomy prognosis of 69%).

Conclusions. The investigated risk factors do not allow clear-cut prediction of relapse-free course of ulcerative colitis for one year of maintenance therapy by infliximab.