title: A retrospective analysis of the efficacy and safety of infliximab as rescue therapy in acute severe ulcerative colitis.
abstract: BACKGROUND
  Forty per cent of patients with acute severe ulcerative colitis will not respond to intravenous corticosteroids and require second-line medical therapy or colectomy. A recent controlled trial has suggested that infliximab may be effective as rescue therapy.
  
  
  OBJECTIVE
  To assess the value of infliximab as rescue therapy for acute severe colitis in a retrospective cohort of ulcerative colitis patients in Scotland.
  
  
  METHODS
  All patients satisfied Truelove and Witts criteria on admission, failed to respond to intravenous corticosteroids and received infliximab (5 mg/kg) as rescue therapy. Response was defined as need for colectomy at hospital discharge and by 90 days.
  
  
  RESULTS
  A total of 39 patients (median age 31.7 years) were treated. 26/39 (66%) responded, avoiding colectomy during the acute admission, and were followed up for a median of 203 days (Interquartile range = 135.5-328.5). Hypoalbuminaemia was a consistent predictor of non-response on univariate and multivariate analysis. At day 3 of intravenous steroids, 9/18 (50.0%) with serum albumin <34 g/L had urgent colectomy vs. 1/13 (7.7%) >or=34 g/L (P = 0.02, OR = 12.0, C.I. 1.28-112.7). Two serious adverse events occurred - one death due to Pseudomonas pneumonia, and one post-operative fungal septicaemia.
  
  
  CONCLUSIONS
  Infliximab represents a moderately effective rescue therapy for patients with acute severe ulcerative colitis. Serious adverse events, including death, do occur and should be discussed with patients prior to therapy.
authors.affiliation: Gastrointestinal Unit, Western General Hospital, Edinburgh, UK. Charlie.lees@ed.ac.uk
authors.forename: C W
authors.initials: CW
authors.lastname: Lees
authors.forename: D
authors.initials: D
authors.lastname: Heys
authors.forename: G T
authors.initials: GT
authors.lastname: Ho
authors.forename: C L
authors.initials: CL
authors.lastname: Noble
authors.forename: A G
authors.initials: AG
authors.lastname: Shand
authors.forename: C
authors.initials: C
authors.lastname: Mowat
authors.forename: R
authors.initials: R
authors.lastname: Boulton-Jones
authors.forename: A
authors.initials: A
authors.lastname: Williams
authors.forename: N
authors.initials: N
authors.lastname: Church
authors.forename: J
authors.initials: J
authors.lastname: Satsangi
authors.forename: I D R
authors.initials: ID
authors.lastname: Arnott
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab