Infliximab in ulcerative colitis: real-life analysis of factors predicting treatment discontinuation due to lack of response or colectomy: ECIA (ACAD Colitis and Infliximab Study)
| Autor: | Maite Herranz, Montserrat Rivero, R. Pajares, Concepción Pedrero Muñoz, Ramon Sanchez-Ocana, Abdel Bouhmidi, Jesus Barrio, Diana Joao, Luis Fernández-Salazar, Fernando Santos, Jesús Legido, Vanessa Prieto, Nereida Fernández, Fernando Muñoz |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Poor prognosis medicine.medical_specialty medicine.medical_treatment Calcineurin Inhibitors Drug Resistance Logistic regression Gastroenterology Maintenance Chemotherapy 03 medical and health sciences 0302 clinical medicine Gastrointestinal Agents Adrenal Cortex Hormones Risk Factors Internal medicine Azathioprine Epidemiology medicine Humans Leukapheresis Treatment Failure Colitis Colectomy Retrospective Studies Mercaptopurine business.industry Induction Chemotherapy Middle Aged Protective Factors Prognosis medicine.disease Ulcerative colitis Infliximab Discontinuation 030220 oncology & carcinogenesis Disease Progression Colitis Ulcerative Drug Therapy Combination Female 030211 gastroenterology & hepatology business Immunosuppressive Agents medicine.drug |
| Zdroj: | Scandinavian Journal of Gastroenterology. 51:186-195 |
| ISSN: | 1502-7708 0036-5521 |
| DOI: | 10.3109/00365521.2015.1070900 |
| Popis: | To describe clinical practice with infliximab (IFX) in ulcerative colitis (UC); identification of predictive factors for IFX treatment discontinuation due to insufficient response and for colectomy.Retrospective, multicentric and observational study including every UC IFX-treated patient in 10 Spanish hospitals. Variables analyzed: epidemiological data; variables for poor prognosis; IFX prior treatments; characteristics of the IFX treatment; time from the UC diagnosis to induction with IFX; time from induction to colectomy or until data collection. Predictive and protective factors for IFX discontinuation due to lack of response and for colectomy were analyzed with binary logistic regression and Cox analysis.Follow-up time from induction with IFX to the collection of data or colectomy: 36.7 ± 25.7 months. Prior treatment with immunomodulator medications (IMM): 79%; IFX + immunosuppressant therapy: 77%; discontinuation of IFX: 26%, colectomy 16%. Independent predictive or protective factors for IFX discontinuation: IMM resistance (OR: 2.9, p = 0.022, 95% CI: 1.2-7.2), prior use of leukocytapheresis (OR: 3.3, p = 0.024, 95% CI: 1.1-9.4), IFX + IMM therapy (OR: 0.3, p = 0.022, 95% CI: 0.1-0.9, and HR: 0.4, p = 0.006, 95% CI: 0.2-0.8) and corticosteroid use in induction (HR: 1.9, p = 0.049, 95% CI: 1.0-3.8). Independent predictive or protective factors for colectomy: Use of leukocytapheresis (OR: 3.0, p = 0.036, 95% CI: 1.1-8.4), IFX + IMM therapy (OR: 0.3, p = 0.022, 95% CI: 0.1-0.8, and HR: 0.3, p = 0.011, 95% CI: 0.1-0.8) and severe cortico-resistant flare-up (HR: 2.5, p = 0.032, 95% CI: 1.1-5.9).Prior use of IMM and leukocytapheresis, the use of corticosteroids in induction and a severe cortico-resistant flare predict a worse response to IFX and the need for colectomy. Combination therapy is a protective factor for both. |
| Databáze: | OpenAIRE |
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