title: Infliximab in ulcerative colitis: real-life analysis of factors predicting treatment discontinuation due to lack of response or colectomy: ECIA (ACAD Colitis and Infliximab Study).
abstract: OBJECTIVE
  To describe clinical practice with infliximab (IFX) in ulcerative colitis (UC); identification of predictive factors for IFX treatment discontinuation due to insufficient response and for colectomy.
  
  
  METHODS
  Retrospective, multicentric and observational study including every UC IFX-treated patient in 10 Spanish hospitals. Variables analyzed: epidemiological data; variables for poor prognosis; IFX prior treatments; characteristics of the IFX treatment; time from the UC diagnosis to induction with IFX; time from induction to colectomy or until data collection. Predictive and protective factors for IFX discontinuation due to lack of response and for colectomy were analyzed with binary logistic regression and Cox analysis.
  
  
  RESULTS
  Follow-up time from induction with IFX to the collection of data or colectomy: 36.7 ± 25.7 months. Prior treatment with immunomodulator medications (IMM): 79%; IFX + immunosuppressant therapy: 77%; discontinuation of IFX: 26%, colectomy 16%. Independent predictive or protective factors for IFX discontinuation: IMM resistance (OR: 2.9, p = 0.022, 95% CI: 1.2-7.2), prior use of leukocytapheresis (OR: 3.3, p = 0.024, 95% CI: 1.1-9.4), IFX + IMM therapy (OR: 0.3, p = 0.022, 95% CI: 0.1-0.9, and HR: 0.4, p = 0.006, 95% CI: 0.2-0.8) and corticosteroid use in induction (HR: 1.9, p = 0.049, 95% CI: 1.0-3.8). Independent predictive or protective factors for colectomy: Use of leukocytapheresis (OR: 3.0, p = 0.036, 95% CI: 1.1-8.4), IFX + IMM therapy (OR: 0.3, p = 0.022, 95% CI: 0.1-0.8, and HR: 0.3, p = 0.011, 95% CI: 0.1-0.8) and severe cortico-resistant flare-up (HR: 2.5, p = 0.032, 95% CI: 1.1-5.9).
  
  
  CONCLUSIONS
  Prior use of IMM and leukocytapheresis, the use of corticosteroids in induction and a severe cortico-resistant flare predict a worse response to IFX and the need for colectomy. Combination therapy is a protective factor for both.
authors.affiliation: a 1 Gastroenterology Unit, Hospital Clínico Universitario , Valladolid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Fernández-Salazar
authors.affiliation: b 2 Gastroenterology Unit, Complejo Asistencial Universitario , León, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Muñoz
authors.affiliation: c 3 Gastroenterology Unit, Hospital Universitario Río Hortega , Valladolid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Barrio
authors.affiliation: d 4 Gastroenterology Unit, Hospital Virgen de la Salud , Toledo, Spain.
authors.forename: Concepción
authors.initials: C
authors.lastname: Muñoz
authors.affiliation: e 5 Gastroenterology Unit, Hospital Infanta Sofía, San Sebastián de los Reyes , Madrid, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Pajares
authors.affiliation: f 6 Gastroenterology Unit, Hospital Universitario Marqués de Valdecilla , Santander, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rivero
authors.affiliation: g 7 Gastroenterology Unit, Complejo Asistencial Universitario , Salamanca, Spain.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Prieto
authors.affiliation: h 8 Gastroenterology Unit, Complejo Asistencial , Segovia, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Legido
authors.affiliation: i 9 Gastroenterology Unit, Hospital Santa Bárbara de Puertollano , Ciudad Real, Spain.
authors.forename: Abdel
authors.initials: A
authors.lastname: Bouhmidi
authors.affiliation: j 10 Gastroenterology Unit, Complejo Asistencial , Ávila, Spain.
authors.forename: Maite
authors.initials: M
authors.lastname: Herranz
authors.affiliation: b 2 Gastroenterology Unit, Complejo Asistencial Universitario , León, Spain.
authors.forename: Nereida
authors.initials: N
authors.lastname: Fernández
authors.affiliation: c 3 Gastroenterology Unit, Hospital Universitario Río Hortega , Valladolid, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Sánchez-Ocaña
authors.affiliation: b 2 Gastroenterology Unit, Complejo Asistencial Universitario , León, Spain.
authors.forename: Diana
authors.initials: D
authors.lastname: Joao
authors.affiliation: c 3 Gastroenterology Unit, Hospital Universitario Río Hortega , Valladolid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Santos
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery*; D018450:Disease Progression; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D060828:Induction Chemotherapy / Q000379:methods; D000069285:Infliximab / Q000627:therapeutic use*; D007937:Leukapheresis; D060046:Maintenance Chemotherapy / Q000379:methods; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use; D008875:Middle Aged; D011379:Prognosis; D065840:Protective Factors; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D000305:Adrenal Cortex Hormones; D065095:Calcineurin Inhibitors; D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D000069285:Infliximab; D015122:Mercaptopurine; D001379:Azathioprine
keywords: colectomy; infliximab; predictive factors; treatment discontinuation; ulcerative colitis