Infliximab as rescue medication for patients with severe ulcerative/indeterminate colitis refractory to tacrolimus

Aliment Pharmacol Ther 31, 1036–1041 Summary Background The calcineurin inhibitor tacrolimus and the anti‐TNF‐antibody infliximab are established options in steroid‐refractory ulcerative colitis (UC). Aim To evaluate the efficacy of infliximab‐salvage therapy in patients with refractory UC failing to respond to tacrolimus. Methods Twenty‐four patients were enrolled in this evaluation. Reasons for tacrolimus therapy were steroid‐refractory disease in 19 patients and steroid‐dependency in five patients. All patients receiving infliximab had tacrolimus‐refractory active disease (Lichtiger score >10) and were treated with 5 mg/kg at weeks 0, 2 and 6 and every 8 weeks thereafter, if tolerated. Results Six of 24 patients (25%) achieved remission following infliximab infusion and four of 24 (17%) had an initial response only, but underwent proctocolectomy later because of loss of response (3) or development of a delayed hypersensitivity reaction (1). Fourteen patients (58%) completely failed to respond with 10 undergoing colectomy. Eight patients experienced side effects under infliximab, including two infectious complications (herpes zoster and herpes pneumonia). Conclusions Infliximab offers a therapeutic option as rescue therapy in about a quarter of patients with active UC after failing to respond to tacrolimus. This benefit has to be weighed against the risks of infectious complications.