title: Infliximab salvage therapy for patients with ulcerative colitis who failed to respond to tacrolimus.
abstract: OBJECTIVE
  Infliximab and tacrolimus are effective for the treatment of patients with moderate or severe corticosteroid-dependent/refractory ulcerative colitis. However, regarding treatment for these patients, whether tacrolimus therapy should precede infliximab as a second-line therapy remains controversial. To address this issue, we retrospectively investigated the efficacy of infliximab salvage therapy for patients with severe or moderate ulcerative colitis who failed to respond to tacrolimus.
  
  
  METHODS
  We assessed clinical backgrounds and therapeutic outcomes at baseline, 8, and 30 weeks for 13 patients receiving infliximab for severe or moderate ulcerative colitis who showed refractoriness or loss of response to tacrolimus, or no tolerance.
  
  
  RESULTS
  Mean partial Mayo score was significantly decreased (P<0.05) to 5.69, 3.07, and 2.77 at baseline, 8, and 30 weeks, respectively. Six of 13 patients (46.2%) showed clinical remission at 8 weeks and four (30.8%) showed clinical remission at 30 weeks. Two patients who did not respond to infliximab finally underwent colectomy. Rates of clinical remission at 8 and 30 weeks were 60.0 and 40.0% in tacrolimus responders, and good remission rates of 37.5 and 25.0%, respectively, were also obtained in tacrolimus nonresponders. No serious adverse events were encountered.
  
  
  CONCLUSIONS
  Infliximab salvage therapy following tacrolimus tended to appear more efficacious in tacrolimus responders (loss of response or no tolerance) than in nonresponders (refractoriness), although nonresponders also achieved satisfactory results. Sequential therapy may thus prove useful and well tolerated. In addition, we should avoid missing the proper timing of colectomy, and care is warranted regarding adverse events.
authors: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Hironobu
authors: H
authors: Tsukamoto
authors: Satoshi
authors: S
authors: Tanida
authors: Tsutomu
authors: T
authors: Mizoshita
authors: Keiji
authors: K
authors: Ozeki
authors: Masahide
authors: M
authors: Ebi
authors: Takaya
authors: T
authors: Shimura
authors: Yoshinori
authors: Y
authors: Mori
authors: Hiromi
authors: H
authors: Kataoka
authors: Takeshi
authors: T
authors: Kamiya
authors: Takashi
authors: T
authors: Joh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D004334:Drug Administration Schedule; D004341:Drug Evaluation / Q000379:methods; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D012720:Severity of Illness Index; D016559:Tacrolimus / Q000627:therapeutic use; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011239:Prednisolone; D000069285:Infliximab; D016559:Tacrolimus