检查英夫利昔单抗挽救治疗急性重度溃疡性结肠炎后的维持治疗。

Examining maintenance care following infliximab salvage therapy for acute severe ulcerative colitis.

机构信息

Department of Gastroenterology, Austin Health, Melbourne, Australia.

Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Australia.

出版信息

J Gastroenterol Hepatol. 2018 Jan;33(1):226-231. doi: 10.1111/jgh.13850.

DOI:10.1111/jgh.13850

PMID:28618062

Abstract

BACKGROUND AND AIM

Data supporting the optimal maintenance drug therapy and strategy to monitor ongoing response following successful infliximab (IFX) induction, for acute severe ulcerative colitis (ASUC), are limited. We aimed to evaluate maintenance and monitoring strategies employed in patients post-IFX induction therapy.

METHODS

Patients in six Australian tertiary centers treated with IFX for steroid-refractory ASUC between April 2014 and May 2015 were identified via hospital IBD and pharmacy databases. Patients were followed up for 1 year with clinical data over 12 months recorded. Analysis was limited to patient outcomes beyond 3 months.

RESULTS

Forty one patients were identified. Five of the 41 (12%) patients underwent colectomy within 3 months, and one patient was lost to follow-up. Six of 35 (17%) of the remaining patients progressed to colectomy by 12 months. Maintenance therapy: Patients maintained on thiopurine monotherapy (14/35) versus IFX/thiopurine therapy (15/35) were followed up. Two of 15 (13%) patients who received combination maintenance therapy underwent a colectomy at 12 months, compared with 1/14 (7%) patients receiving thiopurine monotherapy (P = 0.610). Monitoring during maintenance: Post-discharge, thiopurine metabolites were monitored in 15/27 (56%); fecal calprotectin in 11/32 (34%); and serum IFX levels in 4/20 (20%). Twenty of 32 (63%) patients had an endoscopic evaluation after IFX salvage with median time to first endoscopy of 109 days (interquartile range 113-230).

CONCLUSION

Following IFX induction therapy for ASUC, the uptake of maintenance therapy in this cohort and strategies to monitor ongoing response were variable. These data suggest that the optimal maintenance and monitoring strategy post-IFX salvage therapy remains to be defined.

摘要

背景与目的

对于急性重度溃疡性结肠炎（ASUC），支持成功使用英夫利昔单抗（IFX）诱导后最佳维持药物治疗和监测持续反应的相关数据有限。我们旨在评估接受 IFX 诱导治疗后的患者的维持和监测策略。

方法

通过医院的 IBD 和药房数据库，于 2014 年 4 月至 2015 年 5 月期间在澳大利亚的六家三级中心，确定了接受 IFX 治疗的皮质类固醇难治性 ASUC 患者。通过 12 个月的临床数据对患者进行了为期 1 年的随访。分析仅限于 3 个月后患者的结局。

结果

确定了 41 例患者。41 例患者中有 5 例（12%）在 3 个月内行结肠切除术，1 例患者失访。其余 35 例患者中有 6 例（17%）在 12 个月内进展为结肠切除术。维持治疗：对接受硫嘌呤单药治疗（14/35）与 IFX/硫嘌呤治疗（15/35）的患者进行了随访。在接受联合维持治疗的 15 例患者中，有 2 例（13%）在 12 个月时行结肠切除术，而接受硫嘌呤单药治疗的 14 例患者中，有 1 例（7%）（P=0.610）。维持期间的监测：在出院后，监测了 15/27（56%）例患者的硫嘌呤代谢物，11/32（34%）例患者的粪便钙卫蛋白，4/20（20%）例患者的血清 IFX 水平。在 IFX 挽救治疗后，有 20/32（63%）例患者进行了内镜评估，首次内镜检查的中位时间为 109 天（四分位间距 113-230）。