Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2015; 21(11): 3282-3290
Published online Mar 21, 2015. doi: 10.3748/wjg.v21.i11.3282
Real-life outcome of anti-tumor necrosis factor α in the ambulatory treatment of ulcerative colitis
Enayatullah Baki, Philipp Zwickel, Anna Zawierucha, Robert Ehehalt, Daniel Gotthardt, Wolfgang Stremmel, Annika Gauss
Enayatullah Baki, Philipp Zwickel, Anna Zawierucha, Daniel Gotthardt, Wolfgang Stremmel, Annika Gauss, Division of Gastroenterology, University of Heidelberg, 69120 Heidelberg, Germany
Robert Ehehalt, Outpatient Clinic of Gastroenterology, 69121 Heidelberg, Germany
Author contributions: Gauss A and Baki E designed the research; Baki E performed the research; Gauss A wrote the manuscript; Zwickel P, Zawierucha A and Ehehalt R collected data and contributed to analysis and interpretation of data; Gotthardt D and Stremmel W contributed to analysis and interpretation of data; all authors revised the manuscript critically and approved its final version.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Annika Gauss, MD, Division of Gastroenterology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
Telephone: +49-6221-5638865 Fax: +49-6221-565255
Received: September 14, 2014
Peer-review started: September 15, 2014
First decision: October 14, 2014
Revised: October 24, 2014
Accepted: December 1, 2014
Article in press: December 1, 2014
Published online: March 21, 2015

AIM: To evaluate the outcome of anti-tumor necrosis factor alpha (anti-TNFα) therapy in outpatients with ulcerative colitis at a tertiary referral center.

METHODS: All patients with a confirmed diagnosis of ulcerative colitis undergoing therapy with infliximab and/or adalimumab at the outpatient clinic for inflammatory bowel diseases at the University Hospital Heidelberg between January 2011 and February 2014 were retrospectively enrolled. Patients with a follow-up period of less than 6 mo from start of anti-TNFα therapy were excluded. Medical records of all eligible individuals were carefully reviewed. Steroid-free clinical remission of a duration of at least 3 mo, colectomy rate, duration of anti-TNFα therapy, need for anti-TNFα dose escalation, and the occurrence of adverse events were evaluated as the main outcome parameters.

RESULTS: Seventy-two patients were included (35 treated with infliximab, 17 with adalimumab, 20 with both consecutively). Median follow-up was 27 mo (range: 6-87 mo). Steroid-free clinical remission was achieved by 22.2% of the patients (median duration: 21 mo until end of follow-up; range: 3-66 mo). Patients attaining steroid-free clinical remission displayed lower hemoglobin and albumin blood levels at the start of treatment than those who did not achieve remission. The overall colectomy rate was 20.8%. Nearly 50% of the patients underwent anti-TNFα dose escalation during the follow-up period. For both the infliximab and the adalimumab treated patients, non-response to anti-TNFα therapy was the major reason for treatment discontinuation. 18.2% of the infliximab-treated patients and 13.5% of the adalimumab-treated patients had to discontinue their therapy due to adverse events.

CONCLUSION: Real-life remission rates of ulcerative colitis under anti-TNFα are overall low, but some patients have a clear long-term benefit.

Keywords: Inflammatory bowel disease, Tumor necrosis factor α inhibitors, Ulcerative colitis, Outcome, Real life

Core tip: Tumor necrosis factor alpha inhibitors are a widely accepted therapeutic option for the treatment of ulcerative colitis. Results from different real-life settings on their use in ulcerative colitis are controversial. Weighing anti tumor necrosis factor alpha against other treatment options, it is very important to decide on the best therapy for a patient. This retrospective study from a tertiary referral centre shows a rate of steroid-free clinical remission of 22.2% and a colectomy rate of 20.8% for ambulatory patients with ulcerative colitis under therapy with tumor necrosis factor alpha inhibitors. These rather disappointing outcomes should be thoroughly discussed with the patients before start of therapy.