A review of infliximab use in ulcerative colitis
- PMID: 18343261
- DOI: 10.1016/j.clinthera.2008.02.014
A review of infliximab use in ulcerative colitis
Abstract
Background: Infliximab is a chimeric immunoglobulin G1kappa monoclonal antibody that binds with high affinity and specificity to the soluble form of tumor necrosis factor (TNF)-alpha, preventing it from binding to cellular receptors. Infliximab also binds to membranebound TNF-alpha found on inflammatory cell surfaces, inducing apoptosis. Currently, infliximab is used for the induction and maintenance of remission in Crohn's disease (CD), with documented success. Infliximab's efficacy in the treatment of ulcerative colitis (UC) is now being investigated due to the similarities in the pathophysiology of CD and UC.
Objective: The aim of this study was to review and evaluate the current literature of infliximab use in steroid-refractory UC to assess its role in treatment.
Methods: A search of MEDLINE was conducted (1950-November 2007). Key terms included, but were not limited to, infliximab, inflammatory bowel disease, ulcerative colitis, cost, and quality of life. Studies included for review were limited to English-language, full-text, randomized, double-blind, placebo-controlled trials. Clinical trials were reviewed and summarized.
Results: Four controlled clinical trials of infliximab in the treatment of steroid-refractory UC were found and assessed. In a double-blind, randomized, controlled trial in 43 patients with moderately severe, glucocorticoid-resistant UC, infliximab and placebo were not significantly different with respect to clinical and sigmoidoscopic remission or quality of life 2 and 6 weeks after infliximab treatment. In a multicenter, randomized, double-blind, placebo-controlled study in 45 patients with moderately severe to severe glucocorticoid-resistant UC, infliximab was associated with a significantly reduced need for colectomy compared with placebo (29% vs 67%; P=0.017). The Active Ulcerative Colitis Trials (ACT) 1 and 2 together included 728 patients with moderate to severe glucocorticoid-resistant UC. The primary outcome, the rate of clinical response at 8 weeks, was significantly higher with infliximab compared with placebo (5 mg/kg: ACT 1, 69.4%, ACT 2, 64.5%; 10 mg/kg: ACT 1, 61.5%, ACT 2, 69.2%; placebo: ACT 1, 37.2%;, ACT 2, 29.3%; all, P < 0.001 vs placebo). Based on the data from ACT 1 and 2, infliximab was associated with improved health-related quality-of-life (HRQOL) scores based on the Inflammatory Bowel Disease Questionnaire and the 36-item Short Form Health Survey.
Conclusions: Current data suggest that infliximab is an effective alternative treatment option for patients with moderate to severe UC with an inadequate response to conventional glucocorticoid treatment. Further trials are needed to assess infliximab's impact on the treatment and progression of UC, the HRQL of patients with UC, and the economic impact on the health care system.
Similar articles
-
The effects of infliximab therapy on health-related quality of life in ulcerative colitis patients.Am J Gastroenterol. 2007 Apr;102(4):794-802. doi: 10.1111/j.1572-0241.2007.01094.x. Epub 2007 Feb 23. Am J Gastroenterol. 2007. PMID: 17324131 Clinical Trial.
-
Infliximab use in luminal Crohn's disease.Gastroenterol Clin North Am. 2006 Dec;35(4):775-93. doi: 10.1016/j.gtc.2006.09.003. Gastroenterol Clin North Am. 2006. PMID: 17129813 Review.
-
[Use of infliximab in ulcerative colitis].Z Gastroenterol. 2007 Aug;45(8):907-11. doi: 10.1055/s-2007-963393. Z Gastroenterol. 2007. PMID: 17701864 German.
-
Careful patient selection may improve response rates to infliximab in inflammatory bowel disease.J Gastroenterol Hepatol. 2007 Oct;22(10):1671-7. doi: 10.1111/j.1440-1746.2006.04739.x. J Gastroenterol Hepatol. 2007. PMID: 17845695
-
Infliximab as a rescue therapy for hospitalized patients with severe ulcerative colitis refractory to systemic corticosteroids.Dig Surg. 2008;25(5):383-6. doi: 10.1159/000170882. Epub 2008 Nov 13. Dig Surg. 2008. PMID: 19005257
Cited by
-
The Role of Tofacitinib in the Treatment of Acute Severe Colitis in Children.J Can Assoc Gastroenterol. 2023 Nov 6;7(2):196-203. doi: 10.1093/jcag/gwad042. eCollection 2024 Apr. J Can Assoc Gastroenterol. 2023. PMID: 38596797 Free PMC article.
-
Panax quinquefolius polysaccharides ameliorate ulcerative colitis in mice induced by dextran sulfate sodium.Front Immunol. 2023 Jun 21;14:1161625. doi: 10.3389/fimmu.2023.1161625. eCollection 2023. Front Immunol. 2023. PMID: 37415978 Free PMC article.
-
Tofacitinib to Treat Severe Acute Refractory Colitis in a Teenager: Case Report and Review of the Literature.JPGN Rep. 2022 Aug 16;3(3):e241. doi: 10.1097/PG9.0000000000000241. eCollection 2022 Aug. JPGN Rep. 2022. PMID: 37168636 Free PMC article.
-
Long-term outcomes of antibiotic combination therapy for ulcerative colitis.Ther Adv Chronic Dis. 2021 Jul 6;12:20406223211028790. doi: 10.1177/20406223211028790. eCollection 2021. Ther Adv Chronic Dis. 2021. PMID: 34285790 Free PMC article.
-
Transcriptome-Guided Drug Repositioning.Pharmaceutics. 2019 Dec 12;11(12):677. doi: 10.3390/pharmaceutics11120677. Pharmaceutics. 2019. PMID: 31842375 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical