title: Extent of Early Clinical Response to Infliximab Predicts Long-term Treatment Success in Active Ulcerative Colitis.
abstract: BACKGROUND
  The long-term effectiveness of infliximab (IFX) in ulcerative colitis (UC) and predictors of treatment response remain poorly characterized.
  
  
  METHODS
  A retrospective cohort study was conducted in 213 consecutive patients with active steroid-refractory or steroid-dependent UC treated with induction and scheduled maintenance IFX at an inflammatory bowel disease referral center. Outcomes included annual steroid-free remission (SFR), IFX failure with discontinuation, colectomy, and serious adverse events.
  
  
  RESULTS
  The 1- and 5-year cumulative probabilities for SFR were 39% and 14%, for IFX failure were 31.7% and 55.6%, and for colectomy were 19.2% and 37.4%, respectively. A sensitivity analysis considering the last clinical observation in patients with incomplete follow-up demonstrated a long-term SFR rate of 36%. Among responders to IFX induction therapy, achieving clinical remission before maintenance IFX therapy predicted SFR at 1 year (adjusted odds ratio = 4.50; 95% CI, 1.75-11.53), whereas the need for IFX dose intensification during the first year of therapy predicted a lower odds of SFR at 1 year (adjusted odds ratio = 0.28; 95% CI, 0.11-0.67) and a greater hazard of IFX failure beyond 1 year (adjusted hazard ratio = 2.57; 95% CI, 1.14-5.81). Older age and shorter UC duration at IFX initiation predicted poorer long-term outcomes.
  
  
  CONCLUSIONS
  In patients with moderate-to-severe UC treated with scheduled IFX at an inflammatory bowel disease center, close to half of the patients are still on IFX at 5 years, although a smaller proportion of patients achieve long-term SFR. The magnitude and stability of early response to IFX is associated with long-term therapeutic benefit to this agent.
authors.affiliation: *The Ottawa Hospital IBD Centre, Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada; and †Mount Sinai Hospital IBD Centre, Department of Medicine, University of Toronto and Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada.
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Murthy
authors.forename: Gordon R
authors.initials: GR
authors.lastname: Greenberg
authors.forename: Kenneth
authors.initials: K
authors.lastname: Croitoru
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Nguyen
authors.forename: Mark S
authors.initials: MS
authors.lastname: Silverberg
authors.forename: A Hillary
authors.initials: AH
authors.lastname: Steinhart
mesh_terms: D000328:Adult; D000367:Age Factors; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage*; D006801:Humans; D000069285:Infliximab / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents; D013256:Steroids; D000069285:Infliximab