Recommendations for the treatment of ulcerative colitis with infliximab: a gastroenterology expert group consensus.
OBJECTIVE
Infliximab is currently the only biologic approved for treatment of adults with moderate to severe, active ulcerative colitis (UC) unresponsive to conventional therapies. It rapidly controls symptoms, induces and sustains steroid-free remission, stimulates mucosal healing, and reduces serious complications. Although infliximab tends to be reserved for patients with severe disease, it may be even more beneficial for moderate disease earlier in the disease course. Therefore, it is important to identify which patients are candidates for infliximab therapy.


METHODS
A collaborative Delphi survey was used to obtain consensus on use of biologic therapy in patients with UC from an expert panel of 12 gastroenterologists with substantial experience using infliximab in clinical practice and clinical trials. The panel also addressed issues that influence the use of infliximab in UC, including its potential as an alternative to surgery.


RESULTS
The panel agreed that: (1) it is necessary to adopt additional treatment goals beyond symptom control, i.e., complete mucosal healing, steroid-free remission, improved QoL, and reduced long-term complications; (2) it may be possible to achieve these treatment goals with infliximab, especially if it is used earlier in the course of UC; and (3) infliximab should be offered as an alternative to surgery in patients being considered for colectomy. The panel also agreed on factors for identifying candidates for infliximab therapy (e.g., persistently active UC, steroid-dependent/refractory disease, and high C-reactive protein).


CONCLUSIONS
This consensus statement provides useful and practical information on how to achieve evolving treatment goals with infliximab in moderate to severe UC.
University Klinik Innere Medizin III, ABT Gastroenterologie, Vienna, Austria. walter.reinisch@meduniwien.ac.at
Walter
W
Reinisch
Gert
G
Van Assche
Ragnar
R
Befrits
William
W
Connell
Geert
G
D'Haens
Subrata
S
Ghosh
Pierre
P
Michetti
Thomas
T
Ochsenkühn
Remo
R
Panaccione
Stefan
S
Schreiber
Mark S
MS
Silverberg
Dario
D
Sorrentino
C Janneke
CJ
van der Woude
Séverine
S
Vermeire
Julian
J
Panes
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery; D003697:Delphi Technique; D006801:Humans; D000069285:Infliximab
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab