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

Baki E1, Zwickel P1, Zawierucha A1, Ehehalt R1, Gotthardt D1, Stremmel W1, Gauss A1. World J Gastroenterol. 2015 Mar 21;21(11):3282-90. doi: 10.3748/wjg.v21.i11.3282.
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1Enayatullah Baki, Philipp Zwickel, Anna Zawierucha, Daniel Gotthardt, Wolfgang Stremmel, Annika Gauss, Division of Gastroenterology, University of Heidelberg, 69120 Heidelberg, Germany.


AIM: To evaluate the outcome of anti-tumor necrosis factor alpha (anti-TNFα) 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-TNFα 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-TNFα therapy, need for anti-TNFα 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-TNFα dose escalation during the follow-up period. For both the infliximab and the adalimumab treated patients, non-response to anti-TNFα 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-TNFα are overall low, but some patients have a clear long-term benefit.

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