title: Infliximab as rescue medication for patients with severe ulcerative/indeterminate colitis refractory to tacrolimus.
abstract: BACKGROUND
  The calcineurin inhibitor tacrolimus and the anti-TNF-antibody infliximab are established options in steroid-refractory ulcerative colitis (UC).
  
  
  OBJECTIVE
  To evaluate the efficacy of infliximab-salvage therapy in patients with refractory UC failing to respond to tacrolimus.
  
  
  METHODS
  Twenty-four patients were enrolled in this evaluation. Reasons for tacrolimus therapy were steroid-refractory disease in 19 patients and steroid-dependency in five patients. All patients receiving infliximab had tacrolimus-refractory active disease (Lichtiger score >10) and were treated with 5 mg/kg at weeks 0, 2 and 6 and every 8 weeks thereafter, if tolerated.
  
  
  RESULTS
  Six of 24 patients (25%) achieved remission following infliximab infusion and four of 24 (17%) had an initial response only, but underwent proctocolectomy later because of loss of response (3) or development of a delayed hypersensitivity reaction (1). Fourteen patients (58%) completely failed to respond with 10 undergoing colectomy. Eight patients experienced side effects under infliximab, including two infectious complications (herpes zoster and herpes pneumonia).
  
  
  CONCLUSIONS
  Infliximab offers a therapeutic option as rescue therapy in about a quarter of patients with active UC after failing to respond to tacrolimus. This benefit has to be weighed against the risks of infectious complications.
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Robert-Bosch-Hospital, Stuttgart, Germany. klaus.herrlinger@rbk.de
authors.forename: K R
authors.initials: KR
authors.lastname: Herrlinger
authors.forename: D N
authors.initials: DN
authors.lastname: Barthel
authors.forename: K J
authors.initials: KJ
authors.lastname: Schmidt
authors.forename: J
authors.initials: J
authors.lastname: Büning
authors.forename: C S
authors.initials: CS
authors.lastname: Barthel
authors.forename: J
authors.initials: J
authors.lastname: Wehkamp
authors.forename: E F
authors.initials: EF
authors.lastname: Stange
authors.forename: K
authors.initials: K
authors.lastname: Fellermann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D004351:Drug Resistance; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D016559:Tacrolimus; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab; D016559:Tacrolimus