Recommendations for the treatment of ulcerative colitis with infliximab: a gastroenterology expert group consensus.

Authors:
Walter Reinisch, Gert Van Assche, Ragnar Befrits, William Connell, Geert D'Haens, Subrata Ghosh, Pierre Michetti, Thomas Ochsenkühn, Remo Panaccione, Stefan Schreiber, Mark S Silverberg, Dario Sorrentino, C Janneke van der Woude, Séverine Vermeire, Julian Panes
Year of publication:
2012
Volume:
6
Issue:
2
Issn:
1873-9946
Journal title abbreviated:
J CROHNS COLITIS
Journal title long:
Journal of Crohn's & colitis : international journal devoted to inflammatory bowel diseases
Impact factor:
6.585
Abstract:
Infliximab is currently the only biologic approved for treatment of adults with moderate to severe, active ulcerative colitis (UC) unresponsive to conventional therapies. It rapidly controls symptoms, induces and sustains steroid-free remission, stimulates mucosal healing, and reduces serious complications. Although infliximab tends to be reserved for patients with severe disease, it may be even more beneficial for moderate disease earlier in the disease course. Therefore, it is important to identify which patients are candidates for infliximab therapy.A collaborative Delphi survey was used to obtain consensus on use of biologic therapy in patients with UC from an expert panel of 12 gastroenterologists with substantial experience using infliximab in clinical practice and clinical trials. The panel also addressed issues that influence the use of infliximab in UC, including its potential as an alternative to surgery.The panel agreed that: (1) it is necessary to adopt additional treatment goals beyond symptom control, i.e., complete mucosal healing, steroid-free remission, improved QoL, and reduced long-term complications; (2) it may be possible to achieve these treatment goals with infliximab, especially if it is used earlier in the course of UC; and (3) infliximab should be offered as an alternative to surgery in patients being considered for colectomy. The panel also agreed on factors for identifying candidates for infliximab therapy (e.g., persistently active UC, steroid-dependent/refractory disease, and high C-reactive protein).This consensus statement provides useful and practical information on how to achieve evolving treatment goals with infliximab in moderate to severe UC.