title: Infliximab in the treatment of steroid-dependent ulcerative colitis.
abstract: OBJECTIVE
  Infliximab has proven efficacious in the treatment of Crohn's disease. Limited and contrasting data are available on effectiveness of anti-TNF alpha therapy in ulcerative colitis. We evaluated the efficacy of infliximab in the management of steroid-dependent ulcerative colitis.
  
  
  METHODS
  We report preliminary data from a randomized, open-label, methylprednisolone-controlled trial of infliximab in the induction and maintenance of remission of patients with moderate to severe steroid-dependent ulcerative colitis. Twenty patients received either three infusion of infliximab (5 mg/kg) at 0, 2 and 6 weeks and thereafter every 8 weeks (group A) or methylprednisolone (0,7-1 mg/kg) daily for one week followed by a tapering regimen up to the minimal dose to maintain a symptom-free condition (group B). Clinical remission was defined as a DAI score less than 3.
  
  
  RESULTS
  Ten patients in group A (DAI: 8.9+/-1.4) achieved remission after the first infusion (DAI: 1.6+/-0,7; p = 0.005) and steroids were progressively discontinued. At present (mean follow-up: 9.8+/-1.1 months), 9 out of 10 patients maintain clinical remission, while one patient relapsed at 3 months. Ten patients in group B (DAI: 8.7+/-1.4) reached clinical remission at one week (DAI: 1.9+/-0.3; p = 0.005). Eight out of 10 patients were maintained at a minimal steroid dosage without any relapse at 9.7+/-1.0 months follow-up. Two patients relapsed at 6 and 8 months, respectively.
  
  
  CONCLUSIONS
  Infliximab seems to be as effective as steroids in the management of moderate to severe steroid-dependent ulcerative colitis. These preliminary data suggest the potential efficacy of repeated treatment with infliximab for short-term maintenance of remission and steroid withdrawal in glucocorticoid-dependent ulcerative colitis.
authors.affiliation: Department of Internal Medicine, Gemelli Hospital, Catholic University of Rome (Italy).
authors.forename: A
authors.initials: A
authors.lastname: Armuzzi
authors.forename: B
authors.initials: B
authors.lastname: De Pascalis
authors.forename: A
authors.initials: A
authors.lastname: Lupascu
authors.forename: P
authors.initials: P
authors.lastname: Fedeli
authors.forename: D
authors.initials: D
authors.lastname: Leo
authors.forename: M C
authors.initials: MC
authors.lastname: Mentella
authors.forename: F
authors.initials: F
authors.lastname: Vincenti
authors.forename: D
authors.initials: D
authors.lastname: Melina
authors.forename: G
authors.initials: G
authors.lastname: Gasbarrini
authors.forename: P
authors.initials: P
authors.lastname: Pola
authors.forename: A
authors.initials: A
authors.lastname: Gasbarrini
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab; D008775:Methylprednisolone