INFLIXIMAB IN THE TREATMENT OF SEVERE STEROID-REFRACTORY ULCERATIVE COLITIS – A CASE REPORT
Abstract
Background. The natural course of ulcerative colitis (UC) can be complicated with an acute severe attack of high degree of activity of inflammation which represents a life-threatening condition. High-dose intravenous steroids have been the treatment of choice for induction of clinical remission of acute severe attack. In corticosteroid refractory ulcerative colitis a surgical therapy is required.
Patients and methods. A case of a ten year-old girl with severe steroid-refractory UC is presented. The treatment with infliximab was introduced with intention to avoid colectomy. After the first infusion of infliximab her condition improved and clinical remission was achieved which was maintained with azathioprine.
Conclusions. Therapy with infliximab can be successful for a severe steroid-refractory UC. The patients treated with infliximab can avoid surgical therapy (colectomy) which can represent a life-long disablement. The achieved remission is best maintained with conventional immunosuppressive therapy (azathioprine or 6-mercaptopurin).
Downloads
References
Hanauer SB, Present DH. The state of the art in the management of inflammatory bowel disease. Rev Gastroenterol Disord 2003; 3: 81–92.
Kamm MA. Review article: maintenance of remission in ulcerative colitis. Aliment Pharmacol Ther 2002; 16: Suppl 4: 21–4.
Escher JC, Taminiau JA, Nieuwenhuis EE, Buller HA, Grand RJ. Treatment of inflammatory bowel disease in childhood: best available evidence. Inflamm Bowel Dis 2003; 9: 34–58.
Ringheanu M, Markowitz J. Inflammatory bowel disease in children. Curr Treat Options Gastroenterol 2002; 5: 181–96.
Ludwig D, Stange EF. Treatment of ulcerative colitis. Hepatogastroenterology 2000; 47: 83–9.
Jarnerot G, Rolny P, Sandberg-Getzen H. Intensive intravenous treatment of ulcerative colitis. Gastroenterology 1985; 89: 1005–13.
Daperno M, Sostegni R, Rocca R et al. Review article: medical treatment of severe ulcerative colitis. Aliment Pharmacol Ther 2002; 16: Suppl 4: 7–12.
Nicholls RJ. Review article: ulcerative colitis – surgical indications and treatment. Aliment Pharmacol Ther 2002; 16: Suppl 4: 25–8.
Fonkalsrud EW, Loar N. Long-term results after colectomy and endorectal ileal pullthrough procedure in children. Ann Surg 1992; 215: 57–62.
Rossi HL, Brand MI, Saclarides TJ. Anal complications after restorative proctocolectomy (J-pouch). Am Surg 2002; 68: 628–30.
MacLean AR, Cohen Z, MacRae HM et al. Risk of small bowel obstruction after the ileal pouch-anal anastomosis. Ann Surg 2002; 235: 200–6.
Lichtiger S, Present DH, Kornbluth A et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med 1994; 330: 1841–5.
Sandborn WJ. Cyclosporine in ulcerative colitis: state of the art. Acta Gastroenterol Belg 2001; 64: 201–4.
Barabino A, Torrente F, Castellano E et al. The use of cyclosporin in paediatric inflammatory bowel disease: an Italian experience. Aliment Pharmacol Ther 2002; 16: 1503–7.
Hawthorne AB. Cyclosporin and refractory colitis. Eur J Gastroenterol Hepatol 2003; 15: 239–44.
McCormack G, McCormack PA, Hyland JM, O’Donoghue DP. Cyclosporin therapy in severe ulcerative colitis: is it worth the effort? Dis Colon Rectum 2002; 45: 1200–5.
Palestine AG, Austin HA, Nussenblatt RB. Renal tubular function in cyclosporin-treated patients. AMJ Med 1986; 81: 419–24.
Von Graffenried B, Krupp P. Side effects of cyclosporine (Sandimmun) in renal transplant recipients and patients with autoimmune diseases. Transplant Proc 1986; 18: 876–83.
Voulgary PV, Drosos AA. Gingival hyperplasia associated with cyclosporin A. J Rheumatol 2002; 29: 2466–6.
Hinterreiter M, Stadler B, Knoflach P. Recurrent septicemia with lethal outcome during and after cyclosporine therapy in severe ulcerative colitis. Acta Med Austriaca 2000; 27: 91–3.
Ishiguro Y. Mucosal proinflammatory cytokine production correlates with endoscopic activity of ulcerative colitis. J Gastroenterol 1999; 34: 66–74.
Monteleone G, Macdonald TT. Manipulation of cytokines in the management of patients with inflammatory bowel disease. Ann Med 2000; 38: 552–60.
Louis E. The immuno-inflammatory reaction in Crohn’s disease and ulcerative colitis: characterisation, genetics and clinical application. Focus on TNF alpha. Acta Gastroenterol Belg 2001; 64: 1–5.
Komatsu M, Kobayashi D, Saito K et al. Tumor necrosis factor-alpha in serum of patients with inflammatory bowel disease as measured by a highly sensitive immuno-PCR. Clin Chem 2001; 47: 1297–301.
Baldassano RN. Anti-TNF therapies have eliminated the need for steroids in pediatric Crohn’s disease: Pro. Why use steroids if safer therapies are available? Inflamm Bowel Dis 2001; 7: 338–41.
Van Den Brande JM, Braat H, Van Den Brink GR et al. Infliximab but not etanercept induces apoptosis in lamina propria T-lymphocytes from patients with Crohn’s disease. Gastroenterology 2003; 124: 1774–85.
Targan SR, Hanauer SB, Van Deventer SJ et al. A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn’s disease. Crohn’s Disease cA2 Study Group. N Engl J Med 1997; 337: 1029–35.
Farrell RJ, Shah SA, Lodhavia PJ, Alsahli M, Falchuk KR, Michtti P, Peppercorn MA. Clinical experience with infliximab therapy in 100 patients with Crohn’s disease. Am J Gastroenterol 2000; 95: 3490–7.
Hanauer B, Feagan BG, Lichtenstein GR et al. ACCENT I Study group. Maintenance infliximab for Crohn’s disease; the ACCENT I randomised trial. Lancet 2002; 4: 359: 1541–9.
Baldassano RN. Surpassing conventional therapies: the role of biologic therapy. J Pediatr Gastroenterol Nutr 2001; 33: Suppl 1: S19–26.
Baldassano RN, Braegger CP, Escher JC, DeWoody K, Hendricks DF, Keenan GF, Winter HS. Infliximab (REMICADE) therapy in the treatment of pediatric Crohn’s disease. Am J Gastroenterol 2003; 98: 717–20.
Serrano MS, Schmidt-Sommerfeld E, Kilbaugh TJ, Brown RF, Udall JN, Mannick EE. Use of infliximab in pediatric patients with inflammatory bowel disease. Ann Pharmacother 2001; 35: 823–8.
Hyams JS, Markowitz J, Wyllie R. Use of infliximab in the treatment of Crohn’s disease in children and adolescents. J Pediatr 2000; 137: 192–6.
Cezard JP, Nouaili N, Talbotec C et al. A prospective study of the efficacy and tolerance of a chimeric antibody to tumor necrosis factors (remicade) in severe pediatric Crohn’s disease. J Pediatr Gastroenterol Nutr 2003; 36: 632–6.
Stephens MC, Shepanski MA, Mamula P, Markowitz JE, Brown KA, Baldassano RN. Safety and steroid-sparing experience using infliximab for Crohn’s disease at a pediatric inflammatory bowel disease center. Am J Gastroenterol 2003; 98: 104–11.
D’Haens G, Van Deventer S, Van Hogenzand R et al. Endoscopic and histological healing with infliximab anti-tumor necrosis factor antibodies in Crohn’s disease: a European multicenter trial. Gastroenterology 1999; 116: 1029–34.
Evans RC, Clarke L, Heath P, Stephens S, Morris AI, Rhodes JM. Treatment of ulcerative colitis with an engineered human anti-TNF alpha antibody CDP571. Aliment Pharmacol Ther 1999; 11: 1031–5.
Kaser A, Mairinger T, Vogel W, Tilg H. Infliximab in severe steroid-refractory ulcerative colitis: a pilot study. Wien Klin Wochenschr 2001; 113: 930–3.
Chey WY, Hussain A, Ryan C, Potter GD, Shah A. Infliximab for refractory ulcerative colitis. Am J Gastroenterol 2001; 96: 2373–81.
Sands BE, Tremaine WJ, Sandborn WJ et al. Infliximab in the treatment of severe, steroid-refractory ulcerative colitis: a pilot study. Inflamm Bowel Dis 2001; 7: 83–8.
Mamula P, Markowitz JE, Brown KA, Hurd LB, Piccoli DA, Baldassano RN. Infliximab as a novel therapy for pediatric ulcerative colitis. J Pediatr Gastroenterol Nutr 2002; 34: 307–11.
Rizzello F, Gionchetti P, Venturi A, Campieri M. Medical treatment of severe ulcerative colitis. Aliment Pharmacol Ther 2003; 17: Suppl 2: 7–10.
Viscido A, Habib FI, Kohn A et al. Infliximab in refractory pouchitis complicated by fistulae following ileo-anal pouch for ulcerative colitis. Aliment Pharmacol Ther 2003; 17: 1263–71.
Probert CS, Hearing SD, Schreiber S, Kuhbacher T, Ghosh S, Arnott ID, Forbes A. Infliximab in moderately severe glucocorticoid resistant ulcerative colitis: a randomised controlled trial. Gut 2003; 52: 998–1002.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
