• Carlos Taxonera, Manuel Barreiro-de Acosta, Marta Calvo, Cristina Saro, Guillermo Bastida, María D Martín-Arranz, Javier P Gisbert, Valle García-Sánchez, Ignacio Marín-Jiménez, Fernando Bermejo, María Chaparro, Ángel Ponferrada, María P Martínez-Montiel, Ramón Pajares, Celia de Gracia, David Olivares, Cristina Alba, Juan L Mendoza, and Ignacio Fernández-Blanco.
• Inflammatory Bowel Disease Unit, Department of Gastroenterology, Hospital Clínico San Carlos, c/Profesor Martín Lagos s/n, 28040, Madrid, Spain. carlos.taxonera@salud.madrid.org.
• Dig. Dis. Sci. 2015 Oct 1; 60 (10): 3075-84.

BackgroundThe outcomes of infliximab dose escalation in ulcerative colitis (UC) have not been well evaluated.AimsTo assess the short- and long-term outcomes of infliximab dose escalation in a cohort of patients with UC.MethodsThis was a multicenter, retrospective, cohort study. All consecutive UC patients who had lost response to infliximab maintenance infusions and who underwent infliximab dose escalation were included. Post-escalation short-term clinical response and remission were evaluated. In the long term, the cumulative probabilities of infliximab failure-free survival and colectomy-free survival were calculated. Predictors of short-term response and event-free survival were estimated using logistic regression analysis and Cox proportional hazard regression analysis.ResultsSeventy-nine patients were included. Fifty-four patients (68.4%) achieved short-term clinical response and 41 patients (51.9%) entered in clinical remission. After a median follow-up of 15 months [interquartile range (IQR) 8-26], 33 patients (41.8%) had infliximab failure. Patients with short-term response had a significantly lower adjusted rate of infliximab failure [hazard ratio (HR) 0.24, 95% confidence interval (CI) 0.12-0.49; p < 0.001]. During a median follow-up of 24 months (IQR 13-34), 9 patients (11.4%) needed colectomy. Short-term response was identified as a predictor of colectomy avoidance (HR 0.14; 95% CI 0.03-0.69; p < 0.007).ConclusionsIn UC patients who lost response to infliximab during maintenance, infliximab dose escalation enabled recovery of short-term response in nearly 70% of patients. In the long term, 58% of patients maintained sustained clinical benefit, and 9 of 10 avoided colectomy. Short-term response was associated with an 86% reduction in the relative risk of colectomy.

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