Infliximab salvage therapy after cyclosporine in an acute flare of chronic ulcerative colitis: DISCUSSION (Part 1)

infliximab as salvage medical therapyThis is the first reported case of using infliximab as salvage medical therapy following failure of intravenous cyclosporine. The clinical situation and patient preference for continued medical therapy resulted in the trial of infliximab. The patient responded with rapid clinical improvement over 48 h but the response lasted only 10 days before she relapsed. A second infusion did not make a clinical difference. This case demonstrates that infliximab is not the best option for acute severe CUC that is refractory to cyclosporine.

When should we regard an acute flare of CUC as refractory to medical management? Chey et al published a series of patients with steroid refractory CUC that improved clinically and endoscopically on a single infusion of infliximab (5 mg/kg). However, there were factors of the study that made it impossible to translate these results to our patient. The patient population in the Chey study was older (average age 60 years, range 19 to 79 years) with some doubt in the diagnosis and a relatively short duration of disease (five of eight patients had disease for less than six years). Furthermore, none of the patients received cyclosporine before infliximab therapy. Another study, published by Sands et al, was a placebo-controlled study testing infliximab at three doses (5, 10, 20 mg/kg) for steroid refractory CUC, that was terminated due to slow recruitment. Although the baseline patient population characteristics more closely resembled the current case, study patients were excluded if they had cyclosporine in the three months before enrolment. Four of eight patients were considered treatment successes at two weeks. One patient who failed infliximab (5 mg/kg) subsequently had further medical therapy with intravenous cyclosporine. Some efficacy of infliximab in steroid refractory CUC was demonstrated but further study is needed. The very best pharmacy is looking forward to helping you make sure your health is in good hands no matter if you need viagra professional canadian pharmacy or any other drugs that will help you deal with your symptoms in the most efficient way.

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