Infliximab in the treatment of medically refractory indeterminate colitis
Article first published online: 19 SEP 2003
Alimentary Pharmacology & Therapeutics
Volume 18, Issue 7, pages 741–747, October 2003
How to Cite
Papadakis, K. A., Treyzon, L., Abreu, M. T., Fleshner, P. R., Targan, S. R. and Vasiliauskas, E. A. (2003), Infliximab in the treatment of medically refractory indeterminate colitis. Alimentary Pharmacology & Therapeutics, 18: 741–747. doi: 10.1046/j.1365-2036.2003.01739.x
- Issue published online: 19 SEP 2003
- Article first published online: 19 SEP 2003
- Accepted for publication 8 July 2003
Aim : To examine the outcome of infliximab intervention in refractory indeterminate colitis.
Methods : Twenty patients with severe, medically refractory indeterminate colitis were treated with infliximab. All patients initially received infliximab, 5 mg/kg, intravenously and, in some patients, the dose was subsequently increased to 10 mg/kg. The number of infusions ranged from one to 16 per patient. Indeterminate colitis was defined as colitis that could not be classified with certainty as Crohn's disease or ulcerative colitis based on traditional clinical, endoscopic and histopathological criteria. The clinical response to infliximab was classified as complete response, partial response or non-response.
Results : Fourteen of the 20 patients (70%) showed a complete response to infliximab treatment, two showed a partial response and four showed no response. The four non-responders underwent colectomy with ileal pouch-anal anastomosis. The resected colon specimen was consistent with ulcerative colitis in all four cases, although two were subsequently re-classified as Crohn's disease. Eight additional patients were subsequently re-classified as having Crohn's disease on longer follow-up evaluation, whilst eight continued to have features of indeterminate colitis. The response rate to infliximab treatment was similar in both groups.
Conclusions : Infliximab is effective in approximately two-thirds of patients with indeterminate colitis, and thus may be considered for patients with refractory disease prior to colectomy. The follow-up time afforded by infliximab treatment may allow for more accurate classification of the disease in a significant proportion of patients whose colitis has indeterminate features at initial presentation.