P408 Long-term efficacy of infliximab in patients with ulcerative colitis – an observational study from a single center in Norway

Abstract

Background: TNF inhibitor is a well-established treatment in mod-erate to severe ulcerative colitis (UC). Treatment failure occurs in a large proportion of patients. There are few long-term observational real-life studies and the clinical course in the period following dis-continuation of TNF treatment, has been little focused. Method(s): We conducted a systematic review of all patient records for the period of 2001-2014. Demographic, clinical and management data were collected. In addition, disease activity, calprotectin level and ongoing use of TNF inhibitor and/or other anti-inflammatory medication at the last follow-up control was especially emphasized. All data were analysed using PASW version 24. Result(s): A total of 87 patients started infliximab treatment until the end of 2011. Of these, 61% were men, mean age 41. Seventy-nine percent had extensive colitis (E3). At start of anti-TNF therapy, 75% used concomitant steroids and 25% used immunomodulators (IMM). 1-year evaluation: Complete remission (CR) (calprotectin <100 mg/kg) was achieved in 45% and partial remission (PR) in 14%. At 1 year, 41% of the patients had discontinued infliximab due to treatment failure or severe adverse events. The last evaluation (up to 14 years of observation; median 6 years): Eleven patients (13%) were in CR and 3 (3%) in PR, 25 (29%) had undergone colectomy, and 27 (31%) had stopped infliximab due to remission. Of these, 10 patients (37%) restarted anti-TNF (4 years observation), all with complete response. After discontinuation of TNF inhibitor (up to 13 years of observa-tion; median 4 years): Sixty-five percent of the patients were classi-fied as being in CR and 23% in PR at the last evaluation (excluding all post-colectomy patients). Thirty-seven percent of the patients were using IMM and 19% used oral steroids. Conclusion(s): Among patients starting infliximab only 13% were in long-term complete remission. Stopping infliximab due to remission was successful in one third. A high proportion of patients were in steroid free complete remission median 4 years after stopping inflix-imab. Exit strategies after successful remission-induction anti-TNF treatment in UC patients is highly requested.