Research Article
Endoscopic Findings during the Early Induction Phase of Infliximab Therapy may Predict its Efficacy for Refractory Ulcerative Colitis
Masayuki Saruta1*, Nobuhiko Komoike1, Yoshinori Arai1, Daisuke Ide1, Tetsuyoshi Iwasaki1, Ryoichi Sawada1, Seiji Arihiro1, Mika Matsuoka1, Tomohiro Kato2and Hisao Tajiri1,21Division of Gastroenterology and Hepatology, Department of Internal Medicine, Japan
2Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
- *Corresponding Author:
- Masayuki Saruta
Division of Gastroenterology and Hepatology
Department of Internal Medicine
The Jikei University School of Medicine
3-25-8 Nishi-shinbashi, Minato-ku
Tokyo 105-0003, Japan
Tel: +81-3-3433-1111
E-mail: m-saruta@pg7.so-net.ne.jp
Received date: July 25, 2015, Accepted date: August 17, 2015, Published date: August 24, 2015
Citation: Saruta M, Komoike N, Arai Y, Ide D, Iwasaki T, et al. (2015) Endoscopic Findings during the Early Induction Phase of Infliximab Therapy may Predict its Efficacy for Refractory Ulcerative Colitis. J Gastrointest Dig Syst 5:324. doi:10.4172/2161-069X.1000324
Copyright: © 2015 Saruta M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Background and Aims: Infliximab (IFX) is one of the most potent and effective treatments for steroid- or immunomodulator-refractory ulcerative colitis (UC). We evaluated the early efficacy of IFX, based on endoscopic findings, and also attempted to define endoscopic findings predictive of IFX efficacy. Methods: Nine patients were treated with IFX induction therapy at weeks 0, 2, and 6. Early efficacy was evaluated, using endoscopic and clinical findings, at week 1 (n=9) and again at weeks 3 (n=3) or 7 (n=4). Efficacy was evaluated using the Mayo, Schroeder, and Rachmilewitz endoscopic (RES) scores. Results: At week 1, 8 of 9 (89%) patients showed a clinical response, and 11% (1 of 9) experienced clinical remission. The mean Mayo score was significantly decreased at week 1 (10 ± 1.2 at baseline vs. 5.6 ± 1.9 at week 1, p<0.001). By week 7, 63% of patients (5 of 8) achieved clinical remission and mucosal healing. We used the RESs at week 1 to evaluate the endoscopic findings and to detect marker(s) predictive of remission. We found that week 1 endoscopic findings of “vascular pattern,” “vulnerability of mucosa,” and “mucosal damage” were predictive. Additionally, C-reactive protein levels at weeks 1 and 6 were positive (>0.3 mg/dl) in the non-remission group, but were negative in the remission group.
