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

Background and AimData supporting the optimal maintenance drug therapy and strategy to monitor ongoing response following successful infliximab (IFX) induction, for acute severe ulcerative colitis (ASUC), are limited. We aimed to evaluate maintenance and monitoring strategies employed in patients post-IFX induction therapy. MethodsPatients in six Australian tertiary centers treated with IFX for steroid-refractory ASUC between April 2014 and May 2015 were identified via hospital IBD and pharmacy databases. Patients were followed up for 1year with clinical data over 12months recorded. Analysis was limited to patient outcomes beyond 3months. ResultsForty one patients were identified. Five of the 41 (12%) patients underwent colectomy within 3months, and one patient was lost to follow-up. Six of 35 (17%) of the remaining patients progressed to colectomy by 12months. Maintenance therapy: Patients maintained on thiopurine monotherapy (14/35) versus IFX/thiopurine therapy (15/35) were followed up. Two of 15 (13%) patients who received combination maintenance therapy underwent a colectomy at 12months, 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%); fecal calprotectin in 11/32 (34%); and serum IFX levels in 4/20 (20%). Twenty of 32 (63%) patients had an endoscopic evaluation after IFX salvage with median time to first endoscopy of 109days (interquartile range 113-230). ConclusionFollowing IFX induction therapy for ASUC, the uptake of maintenance therapy in this cohort and strategies to monitor ongoing response were variable. These data suggest that the optimal maintenance and monitoring strategy post-IFX salvage therapy remains to be defined.