title: Real-life outcome of anti-tumor necrosis factor α in the ambulatory treatment of ulcerative colitis.
abstract: OBJECTIVE
  To evaluate the outcome of anti-tumor necrosis factor alpha (anti-TNFα) therapy in outpatients with ulcerative colitis at a tertiary referral center.
  
  
  METHODS
  All patients with a confirmed diagnosis of ulcerative colitis undergoing therapy with infliximab and/or adalimumab at the outpatient clinic for inflammatory bowel diseases at the University Hospital Heidelberg between January 2011 and February 2014 were retrospectively enrolled. Patients with a follow-up period of less than 6 mo from start of anti-TNFα therapy were excluded. Medical records of all eligible individuals were carefully reviewed. Steroid-free clinical remission of a duration of at least 3 mo, colectomy rate, duration of anti-TNFα therapy, need for anti-TNFα dose escalation, and the occurrence of adverse events were evaluated as the main outcome parameters.
  
  
  RESULTS
  Seventy-two patients were included (35 treated with infliximab, 17 with adalimumab, 20 with both consecutively). Median follow-up was 27 mo (range: 6-87 mo). Steroid-free clinical remission was achieved by 22.2% of the patients (median duration: 21 mo until end of follow-up; range: 3-66 mo). Patients attaining steroid-free clinical remission displayed lower hemoglobin and albumin blood levels at the start of treatment than those who did not achieve remission. The overall colectomy rate was 20.8%. Nearly 50% of the patients underwent anti-TNFα dose escalation during the follow-up period. For both the infliximab and the adalimumab treated patients, non-response to anti-TNFα therapy was the major reason for treatment discontinuation. 18.2% of the infliximab-treated patients and 13.5% of the adalimumab-treated patients had to discontinue their therapy due to adverse events.
  
  
  CONCLUSIONS
  Real-life remission rates of ulcerative colitis under anti-TNFα are overall low, but some patients have a clear long-term benefit.
authors: Enayatullah Baki, Philipp Zwickel, Anna Zawierucha, Daniel Gotthardt, Wolfgang Stremmel, Annika Gauss, Division of Gastroenterology, University of Heidelberg, 69120 Heidelberg, Germany.
authors: Enayatullah
authors: E
authors: Baki
authors: Enayatullah Baki, Philipp Zwickel, Anna Zawierucha, Daniel Gotthardt, Wolfgang Stremmel, Annika Gauss, Division of Gastroenterology, University of Heidelberg, 69120 Heidelberg, Germany.
authors: Philipp
authors: P
authors: Zwickel
authors: Enayatullah Baki, Philipp Zwickel, Anna Zawierucha, Daniel Gotthardt, Wolfgang Stremmel, Annika Gauss, Division of Gastroenterology, University of Heidelberg, 69120 Heidelberg, Germany.
authors: Anna
authors: A
authors: Zawierucha
authors: Enayatullah Baki, Philipp Zwickel, Anna Zawierucha, Daniel Gotthardt, Wolfgang Stremmel, Annika Gauss, Division of Gastroenterology, University of Heidelberg, 69120 Heidelberg, Germany.
authors: Robert
authors: R
authors: Ehehalt
authors: Enayatullah Baki, Philipp Zwickel, Anna Zawierucha, Daniel Gotthardt, Wolfgang Stremmel, Annika Gauss, Division of Gastroenterology, University of Heidelberg, 69120 Heidelberg, Germany.
authors: Daniel
authors: D
authors: Gotthardt
authors: Enayatullah Baki, Philipp Zwickel, Anna Zawierucha, Daniel Gotthardt, Wolfgang Stremmel, Annika Gauss, Division of Gastroenterology, University of Heidelberg, 69120 Heidelberg, Germany.
authors: Wolfgang
authors: W
authors: Stremmel
authors: Enayatullah Baki, Philipp Zwickel, Anna Zawierucha, Daniel Gotthardt, Wolfgang Stremmel, Annika Gauss, Division of Gastroenterology, University of Heidelberg, 69120 Heidelberg, Germany.
authors: Annika
authors: A
authors: Gauss
mesh_terms: D000068879:Adalimumab / Q000008:administration & dosage* / Q000009:adverse effects; D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D004351:Drug Resistance; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D005260:Female; D005858:Germany; D006785:Hospitals, University; D006801:Humans; D000069285:Infliximab / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D013256:Steroids; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab
keywords: Inflammatory bowel disease; Outcome; Real life; Tumor necrosis factor α inhibitors; Ulcerative colitis