Background: Infliximab is effective as rescue therapy in severe corticosteroid-refractory
ulcerative colitis. The optimal dose regimen and the long term benefits are not well defined.
The aim of the present study was to evaluate short- and long-term colectomy rate in a cohort of
patients with severe corticosteroid-refractory ulcerative colitis who received a three-dose
infliximab induction regimen.
Methods: One hundred and thirteen patients admitted to 11 Italian IBD referral centres and
treated with infliximab according to an intention to treat three-dose regimen were included.
The co-primary endpoints were 3- and 12-month colectomy rate. The secondary end-points were
the overall colectomy-free survival and the identification of predictors of colectomy.
Results: The 3- and 12-month colectomy rates were 18.6% (95%CI 11.8%–26.9%) and 25.6%
(95%CI 17.9%–34.7%) respectively. High CRP values and severe endoscopic lesions were
associated with the risk of colectomy: Risk Ratio (RR) = 2.15 (95%CI 1.05–4.36), and RR = 5.13
(95%CI 1.55–16.96), respectively. In patients escaping early colectomy, the probability of a
colectomy-free course at 12, 24, 36 and 60 months was 91%, 85%, 81% and 73%, respectively.
Endoscopic severity was the only predictor of long term colectomy (RR = 7.0; 95%CI 1.09–44.7).
Adverse events occurred in 16 patients (14%); there was one death (0.88%) due to pulmonary
abscess.
Conclusions: Infliximab is an effective and safe rescue therapy for severe corticosteroid-refractory
ulcerative colitis. A three-dose induction regimen seems to be the treatment of choice for preventing
early colectomy. Severe endoscopic lesions appear to be predictor of short- and long-term colectomy