Preoperative infliximab treatment in patients with ulcerative and indeterminate colitis does not increase rate of conversion to emergent and multistep abdominal surgery.
BACKGROUND
A recent study has raised concerns that infliximab treatment, by postpoing surgery for ulcerative and indeterminate colitis patients, may result in a greater need for high-risk emergent or multistep surgical procedures (subtotal colectomies). Our aim was to assess whether infliximab exposure affects rates of subotal colectomy in a large cohort of patients.


METHODS
We evaluated 171 consecutive patients with ulcerative or indeterminate colitis who had a total proctocolectomy or a subtotal colectomy between 1993 and 2006 for symptoms of unremitting disease. Forty-four patients (25.7%) received infliximab prior to surgery. We compared the surgical procedures employed on these 44 patients to the surgical procedures employed on the 127 non-infliximab patients, using Fisher's exact or Student's t test.


RESULTS
Infliximab exposure did not appear to affect the rate of emergent surgery (4.5% vs 4.4%, p = 0.98), rate of subtotal colectomy (19.2% vs. 18.0%, p = 0.99), or rate of ileoanal J pouch reconstruction (53.8% vs. 62%, p = 0.98). Nor did it affect intraoperative findings of perforation, toxic megacolon, and active disease. The infliximab and non-infliximab cohorts were similar in age, Charlson Comorbidity Index, concomitant steroid use, and albumin levels, although infliximab patients had higher rates of concomitant exposure to 6-mercaptopurine (34.1% vs 16.6%, p = 0.02) and azathioprine (40.9% vs 22.6%, p = 0.02).


CONCLUSIONS
Infliximab does not appear to increase rates of emergent surgery or multistep procedures in patients undergoing treatment for ulcerative or indeterminative colitis at our institution.
MGH Crohn's & Colitis Center, Harvard Medical School, Boston, MA 02114, USA. lbordeianou@partners.org
Liliana
L
Bordeianou
Hiroko
H
Kunitake
Paul
P
Shellito
Richard
R
Hodin
D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use*; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery; D039021:Colonic Pouches; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D008297:Male; D019990:Perioperative Care
D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab