Tratamiento de mantenimiento con azatioprina o infliximab en pacientes con colitis ulcerosa corticorrefractarios respondedores a las 3 dosis de inducción de infliximab

Introduction

Infliximab has demonstrated its efficacy in the avoidance of colectomy in the short-medium term in patients with steroid-refractory ulcerative colitis (SRUC). Scarce data are available concerning the best maintenance treatment for patients successfully treated with infliximab induction regimens. The aim of this study is to compare the long-term outcomes of steroid-refractory patients responding to a 3-infusion with infliximab who have followed maintenance therapy with azathioprine monotherapy or infliximab.

Patients and methods

All patients admitted in 3 centres between January 2005 and December 2011 for moderate-to-severe steroid-refractory flare and who responded to a 3-infusion with infliximab and did not undergo colectomy before week 22 from the first infliximab administration were selected.

Results

Twenty-four patients were included. Maintenance treatment consisted of azathioprine monotherapy in 9 (37%), infliximab in 15 (63%). After a median follow-up of 18 months, corticosteroids were completely withdrawn in all patients. Among those patients who followed azathioprine maintenance monotherapy, infliximab had to be reintroduced in 4 (44%). No colectomies were registered in this group. Among 15 patients who were maintained with infliximab, treatment had to be dose-escalated in 53%. However, infliximab was discontinued because of clinical remission in 9 (65%). Colectomy was required in 4 (16%).

Conclusions

In patients with steroid-refractory who avoid early colectomy with a 3-infusion infliximab, infliximab seems to be the best maintenance treatment (even in azathioprine-naïve patients) due to the high proportion of patients who require infliximab reintroduction in case of azathioprine monotherapy maintenance.