title: Anti-TNF alpha in the treatment of ulcerative colitis: a valid approach for organ-sparing or an expensive option to delay surgery?
abstract: Ulcerative colitis (UC) is an inflammatory bowel disease affecting large bowel with variable clinical course. The history of disease has been modified by the introduction of biologic therapy, in particular Infliximab (IFX), that has demonstrated efficacy in inducing fast symptoms remission, promoting mucosal healing and maintaining long-term remission. However, surgery is still needed for UC patients: in case of failure of medical therapy and if acute complications or a malignancy occurred. Surgical treatment is associated with a short-term post-operative mortality and morbidity respectively of 0%-4% and 30%. In this study we systematically analyzed: the role of IFX in reducing the colectomy rate, the risk of post-operative morbidity in pre-operatively IFX-treated patients and the cost-effectiveness of IFX therapy. Four of 5 analyzed randomized controlled trials demonstrated that therapy with IFX significantly reduces the colectomy rate. Moreover, pre-operative treatment with IFX doesn't seem to increase post-operative infectious complications. By an economic point of view, the cost-effectiveness of IFX-therapy was demonstrated for UC patients suffering from moderate to severe UC in a study based on a cost estimation of the National Health Service of England and Wales. However, the argument is debated.
authors.affiliation: Gianluca Rizzo, Claudio Coco, Department of Surgical Sciences, Complesso Integrato Columbus, Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rizzo
authors.affiliation: Gianluca Rizzo, Claudio Coco, Department of Surgical Sciences, Complesso Integrato Columbus, Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Pugliese
authors.affiliation: Gianluca Rizzo, Claudio Coco, Department of Surgical Sciences, Complesso Integrato Columbus, Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Armuzzi
authors.affiliation: Gianluca Rizzo, Claudio Coco, Department of Surgical Sciences, Complesso Integrato Columbus, Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Coco
mesh_terms: D000893:Anti-Inflammatory Agents / Q000191:economics / Q000627:therapeutic use*; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000276:immunology / Q000601:surgery; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D016527:Drug Costs; D005765:Gastrointestinal Agents / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D013222:State Medicine / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D006113:United Kingdom
chemical_list: D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Colectomy; Cost-effectiveness; Inflammatory bowel disease; Infliximab; Post-operative complications; Ulcerative colitis