RISS 검색 - 국내학술지논문 상세보기

다국어 초록 (Multilingual Abstract)

Background/Aims: Infliximab (IFX) has been used to induce and maintain remission in patients with severe steroid-refractory ulcerative colitis (UC). Long-term use of biologics in developing countries is limited by high cost and frequent side effects. An optimal maintenance strategy in these patients needs to be established. Methods: A retrospective analysis of maintenance of clinical remission with combination of azathioprine (AZA) and 5-aminosalicylates (5-ASA) in patients with severe steroid-refractory UC where IFX (5 mg/kg intravenously at weeks 0, 2, 6) had been used only as an induction therapy was done at 2 centers in India. Primary outcome was the proportion of patients maintaining corticosteroid-free sustained clinical remission (SCR) at the end of study period. Rates of relapse and cost of therapy were also analyzed. Results: Of the 137 patients who received rescue IFX induction therapy, 77 (56.2%) achieved clinical remission (mean age 34.81±13.32 years, 68.83% males, median follow-up 4 years, range 3 months to 6 years) and were included. Cumulative corticosteroid-free SCR was maintained in 68%, 59%, 42%, and 35% patients at 1, 2, 4, and 6 years respectively. Sixty-seven relapses were observed in 33 patients. Majority of the relapses (45/67, 67.16%) occurred within first 2 years of follow-up. Two relapses were managed with re-induction with IFX, one required colectomy, whereas all other responded to repeat course(s) of corticosteroids. Annual per capita maintenance therapy with 5-ASA and AZA was cheaper by US$ 4,526 compared to maintaining remission with IFX. Conclusions: Clinical remission achieved with IFX induction therapy in severe steroid-refractory UC can be sustained over long time with a combination of AZA and 5-ASA. (Intest Res 2022;20:64-71)

참고문헌 (Reference)

1 Refojo D, "Transcription factor-mediated molecular mechanisms involved in the functional cross-talk between cytokines and glucocorticoids" 79 : 385-394, 2001

2 Harbord M, "Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 2: current management" 11 : 769-784, 2017

3 Gisbert JP, "The risk of relapse after anti-TNF discontinuation in inflammatory bowel disease : systematic review and meta-analysis" 111 : 632-647, 2016

4 Kang B, "Subtherapeutic infliximab trough levels and complete mucosal healing are associated with sustained clinical remission after infliximab cessation in paediatric-onset Crohn’s disease patients treated with combined immunosuppressive therapy" 12 : 644-652, 2018

5 Nasuno M, "Short-and long-term outcomes of infliximab treatment for steroid-refractory ulcerative colitis and related prognostic factors : a single-center retrospective study" 95 : 67-71, 2017

6 Turner D, "Response to corticosteroids in severe ulcerative colitis : a systematic review of the literature and a meta-regression" 5 : 103-110, 2007

7 Travis SP, "Predicting outcome in severe ulcerative colitis" 38 : 905-910, 1996

8 Nikolaus S, "Mechanisms in failure of infliximab for Crohn’s disease" 356 : 1475-1479, 2000

9 Louis E, "Maintenance of remission among patients with Crohn’s disease on antimetabolite therapy after infliximab therapy is stopped" 142 : 63-70, 2012

10 Roda G, "Loss of response to anti-TNFs : definition, epidemiology, and management" 7 : e135-, 2016