title: Efficacy of anti-tumor necrosis factor therapy in patients with ulcerative colitis.
abstract: OBJECTIVE
  Tumor necrosis factor-alpha (TNF-alpha) is an important cytokine involved in the pathogenesis of inflammatory bowel disease. The monoclonal antibody to TNF-alpha, infliximab, is effective in treating Crohn's disease. Preclinical studies suggest the importance of TNF-alpha in treating ulcerative colitis (UC). We report the effectiveness of infliximab for UC and examine factors predictive of response to medication.
  
  
  METHODS
  Data from all UC patients receiving infliximab at four institutions were analyzed. Disease activity was determined by the Disease Activity Index.
  
  
  RESULTS
  A total of 27 patients with active UC received inpatient (37%) and outpatient (63%) infliximab as single (52%) or multiple (two to 15) infusions (48%). Twelve patients (44%) achieved remission and six patients (22%) had partial response. Nine patients had no response; five subsequently underwent total colectomy. The median time to achieve response and remission was 4 days and the median duration 8 wk. Nine of the 18 patients who responded experienced 19 relapses; 18 of these relapses (95%) were successfully treated with repeat infusions. Steroid-refractory patients were less likely to respond to infliximab therapy than were steroid-responsive patients (33% vs 83%; p = 0.026). No other factors were predictive of response to infliximab. Two patients developed serious adverse events, including death in one case.
  
  
  CONCLUSIONS
  Preliminary evidence suggest effectiveness of infliximab in the treatment of UC, including medically refractory severe disease. Individuals who are refractory to corticosteroids, however, may be unlikely to respond to infliximab. A randomized controlled trial is necessary to further investigate the efficacy of infliximab in patients with UC.
authors.affiliation: Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia 19104-4283, USA.
authors.forename: Chinyu
authors.initials: C
authors.lastname: Su
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Salzberg
authors.forename: James D
authors.initials: JD
authors.lastname: Lewis
authors.forename: Julius J
authors.initials: JJ
authors.lastname: Deren
authors.forename: Asher
authors.initials: A
authors.lastname: Kornbluth
authors.forename: David A
authors.initials: DA
authors.lastname: Katzka
authors.forename: Robert B
authors.initials: RB
authors.lastname: Stein
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Adler
authors.forename: Gary R
authors.initials: GR
authors.lastname: Lichtenstein
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D005260:Female; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab