Predicting response after infliximab salvage in acute severe ulcerative colitis

Matthew C. Choy, Dean Seah, Alexandra Gorelik, Yoon Kyo An, Cheng Yu Chen, Finlay A. Macrae, Miles P. Sparrow, William R. Connell, Gregory T. Moore, Graham Radford-Smith, Daniel R. Van Langenberg, Peter De Cruz

Research output: Contribution to journalArticleResearchpeer-review

9 Citations (Scopus)

Abstract

Background and Aim: Acute severe ulcerative colitis (ASUC) is a medical emergency requiring prompt therapeutic intervention. Although infliximab has been used as salvage therapy for over 15 years, clinical predictors of treatment success are lacking. We performed a retrospective analysis to identify factors that predict colectomy and may guide dose intensification. Methods: Fifty-four hospitalized patients received infliximab for ASUC at seven Australian centers (April 2014–May 2015). Follow-up was over 12 months. The data were primarily analyzed for predictors of colectomy. Accelerated (AI) versus standard (SI) infliximab induction strategies were also compared. Results: Of 54 patients identified, the overall colectomy rate was 15.38% (8/52) at 3 months and 26.92% (14/52) at 12 months. Two patients were lost to follow-up. There was a numerically higher colectomy rate in those treated with AI compared with SI (P = 0.3); however, those treated with AI had more severe biochemical disease. A C-reactive protein (CRP)/albumin ratio cut-off of 0.37 post-commencement of infliximab and before discharge was a significant predictor of colectomy with an area under receiver operating curve of 0.73. Pretreatment CRP and albumin levels were not predictive of colectomy. A Mayo Endoscopic Score of 2 had a 94% PPV for avoidance of colectomy following infliximab salvage. Conclusions: The baseline Mayo Endoscopic Score and the CRP/albumin ratio following infliximab salvage are significant predictors of treatment response for ASUC and identify patients at high risk of colectomy. Whether this risk can be mitigated using infliximab dose intensification requires prospective evaluation before the CRP/albumin ratio can be integrated into ASUC management algorithms.

Original languageEnglish
Pages (from-to)1347-1352
Number of pages6
JournalJournal of Gastroenterology and Hepatology
Volume33
Issue number7
DOIs
Publication statusPublished - 1 Jul 2018

Keywords

  • colectomy
  • infliximab
  • ulcerative colitis

Cite this

Choy, M. C., Seah, D., Gorelik, A., An, Y. K., Chen, C. Y., Macrae, F. A., ... De Cruz, P. (2018). Predicting response after infliximab salvage in acute severe ulcerative colitis. Journal of Gastroenterology and Hepatology, 33(7), 1347-1352. https://doi.org/10.1111/jgh.14072
Choy, Matthew C. ; Seah, Dean ; Gorelik, Alexandra ; An, Yoon Kyo ; Chen, Cheng Yu ; Macrae, Finlay A. ; Sparrow, Miles P. ; Connell, William R. ; Moore, Gregory T. ; Radford-Smith, Graham ; Van Langenberg, Daniel R. ; De Cruz, Peter. / Predicting response after infliximab salvage in acute severe ulcerative colitis. In: Journal of Gastroenterology and Hepatology. 2018 ; Vol. 33, No. 7. pp. 1347-1352.
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title = "Predicting response after infliximab salvage in acute severe ulcerative colitis",
abstract = "Background and Aim: Acute severe ulcerative colitis (ASUC) is a medical emergency requiring prompt therapeutic intervention. Although infliximab has been used as salvage therapy for over 15 years, clinical predictors of treatment success are lacking. We performed a retrospective analysis to identify factors that predict colectomy and may guide dose intensification. Methods: Fifty-four hospitalized patients received infliximab for ASUC at seven Australian centers (April 2014–May 2015). Follow-up was over 12 months. The data were primarily analyzed for predictors of colectomy. Accelerated (AI) versus standard (SI) infliximab induction strategies were also compared. Results: Of 54 patients identified, the overall colectomy rate was 15.38{\%} (8/52) at 3 months and 26.92{\%} (14/52) at 12 months. Two patients were lost to follow-up. There was a numerically higher colectomy rate in those treated with AI compared with SI (P = 0.3); however, those treated with AI had more severe biochemical disease. A C-reactive protein (CRP)/albumin ratio cut-off of 0.37 post-commencement of infliximab and before discharge was a significant predictor of colectomy with an area under receiver operating curve of 0.73. Pretreatment CRP and albumin levels were not predictive of colectomy. A Mayo Endoscopic Score of 2 had a 94{\%} PPV for avoidance of colectomy following infliximab salvage. Conclusions: The baseline Mayo Endoscopic Score and the CRP/albumin ratio following infliximab salvage are significant predictors of treatment response for ASUC and identify patients at high risk of colectomy. Whether this risk can be mitigated using infliximab dose intensification requires prospective evaluation before the CRP/albumin ratio can be integrated into ASUC management algorithms.",
keywords = "colectomy, infliximab, ulcerative colitis",
author = "Choy, {Matthew C.} and Dean Seah and Alexandra Gorelik and An, {Yoon Kyo} and Chen, {Cheng Yu} and Macrae, {Finlay A.} and Sparrow, {Miles P.} and Connell, {William R.} and Moore, {Gregory T.} and Graham Radford-Smith and {Van Langenberg}, {Daniel R.} and {De Cruz}, Peter",
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Choy, MC, Seah, D, Gorelik, A, An, YK, Chen, CY, Macrae, FA, Sparrow, MP, Connell, WR, Moore, GT, Radford-Smith, G, Van Langenberg, DR & De Cruz, P 2018, 'Predicting response after infliximab salvage in acute severe ulcerative colitis', Journal of Gastroenterology and Hepatology, vol. 33, no. 7, pp. 1347-1352. https://doi.org/10.1111/jgh.14072

Predicting response after infliximab salvage in acute severe ulcerative colitis. / Choy, Matthew C.; Seah, Dean; Gorelik, Alexandra; An, Yoon Kyo; Chen, Cheng Yu; Macrae, Finlay A.; Sparrow, Miles P.; Connell, William R.; Moore, Gregory T.; Radford-Smith, Graham; Van Langenberg, Daniel R.; De Cruz, Peter.

In: Journal of Gastroenterology and Hepatology, Vol. 33, No. 7, 01.07.2018, p. 1347-1352.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Predicting response after infliximab salvage in acute severe ulcerative colitis

AU - Choy, Matthew C.

AU - Seah, Dean

AU - Gorelik, Alexandra

AU - An, Yoon Kyo

AU - Chen, Cheng Yu

AU - Macrae, Finlay A.

AU - Sparrow, Miles P.

AU - Connell, William R.

AU - Moore, Gregory T.

AU - Radford-Smith, Graham

AU - Van Langenberg, Daniel R.

AU - De Cruz, Peter

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Background and Aim: Acute severe ulcerative colitis (ASUC) is a medical emergency requiring prompt therapeutic intervention. Although infliximab has been used as salvage therapy for over 15 years, clinical predictors of treatment success are lacking. We performed a retrospective analysis to identify factors that predict colectomy and may guide dose intensification. Methods: Fifty-four hospitalized patients received infliximab for ASUC at seven Australian centers (April 2014–May 2015). Follow-up was over 12 months. The data were primarily analyzed for predictors of colectomy. Accelerated (AI) versus standard (SI) infliximab induction strategies were also compared. Results: Of 54 patients identified, the overall colectomy rate was 15.38% (8/52) at 3 months and 26.92% (14/52) at 12 months. Two patients were lost to follow-up. There was a numerically higher colectomy rate in those treated with AI compared with SI (P = 0.3); however, those treated with AI had more severe biochemical disease. A C-reactive protein (CRP)/albumin ratio cut-off of 0.37 post-commencement of infliximab and before discharge was a significant predictor of colectomy with an area under receiver operating curve of 0.73. Pretreatment CRP and albumin levels were not predictive of colectomy. A Mayo Endoscopic Score of 2 had a 94% PPV for avoidance of colectomy following infliximab salvage. Conclusions: The baseline Mayo Endoscopic Score and the CRP/albumin ratio following infliximab salvage are significant predictors of treatment response for ASUC and identify patients at high risk of colectomy. Whether this risk can be mitigated using infliximab dose intensification requires prospective evaluation before the CRP/albumin ratio can be integrated into ASUC management algorithms.

AB - Background and Aim: Acute severe ulcerative colitis (ASUC) is a medical emergency requiring prompt therapeutic intervention. Although infliximab has been used as salvage therapy for over 15 years, clinical predictors of treatment success are lacking. We performed a retrospective analysis to identify factors that predict colectomy and may guide dose intensification. Methods: Fifty-four hospitalized patients received infliximab for ASUC at seven Australian centers (April 2014–May 2015). Follow-up was over 12 months. The data were primarily analyzed for predictors of colectomy. Accelerated (AI) versus standard (SI) infliximab induction strategies were also compared. Results: Of 54 patients identified, the overall colectomy rate was 15.38% (8/52) at 3 months and 26.92% (14/52) at 12 months. Two patients were lost to follow-up. There was a numerically higher colectomy rate in those treated with AI compared with SI (P = 0.3); however, those treated with AI had more severe biochemical disease. A C-reactive protein (CRP)/albumin ratio cut-off of 0.37 post-commencement of infliximab and before discharge was a significant predictor of colectomy with an area under receiver operating curve of 0.73. Pretreatment CRP and albumin levels were not predictive of colectomy. A Mayo Endoscopic Score of 2 had a 94% PPV for avoidance of colectomy following infliximab salvage. Conclusions: The baseline Mayo Endoscopic Score and the CRP/albumin ratio following infliximab salvage are significant predictors of treatment response for ASUC and identify patients at high risk of colectomy. Whether this risk can be mitigated using infliximab dose intensification requires prospective evaluation before the CRP/albumin ratio can be integrated into ASUC management algorithms.

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U2 - 10.1111/jgh.14072

DO - 10.1111/jgh.14072

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