Sistema gastrointestinal y digestivo

Abstracto

Endoscopic Findings during the Early Induction Phase of Infliximab Therapy may Predict its Efficacy for Refractory Ulcerative Colitis

Masayuki Saruta, Nobuhiko Komoike, Yoshinori Arai, Daisuke Ide, Tetsuyoshi Iwasaki, Ryoichi Sawada, Makoto Mitsunaga, Seiji Arihiro, Mika Matsuoka, Tomohiro Kato, and Hisao Tajiri

Background and Aims: Infliximab (IFX) is one of the most potent and effective treatments for steroid- or immunomodulator-refractory ulcerative colitis (UC). We evaluated the early efficacy of IFX, based on endoscopic findings, and also attempted to define endoscopic findings predictive of IFX efficacy. Methods: Nine patients were treated with IFX induction therapy at weeks 0, 2, and 6. Early efficacy was evaluated, using endoscopic and clinical findings, at week 1 (n=9) and again at weeks 3 (n=3) or 7 (n=4). Efficacy was evaluated using the Mayo, Schroeder, and Rachmilewitz endoscopic (RES) scores. Results: At week 1, 8 of 9 (89%) patients showed a clinical response, and 11% (1 of 9) experienced clinical remission. The mean Mayo score was significantly decreased at week 1 (10 ± 1.2 at baseline vs. 5.6 ± 1.9 at week 1, p<0.001). By week 7, 63% of patients (5 of 8) achieved clinical remission and mucosal healing. We used the RESs at week 1 to evaluate the endoscopic findings and to detect marker(s) predictive of remission. We found that week 1 endoscopic findings of “vascular pattern,” “vulnerability of mucosa,” and “mucosal damage” were predictive. Additionally, C-reactive protein levels at weeks 1 and 6 were positive (>0.3 mg/dl) in the non-remission group, but were negative in the remission group.