P615 Rescue infliximab for acute severe colitis: a single-centre experience

Background
Since the late 1990s the use of biologics in inflammatory bowel disease (IBD) has become well established in clinical practice. The use of anti- tumour necrosis factor (TNF) therapy (infliximab) as ‘rescue’ in steroid refractory disease as an alternative to surgery or Cyclosporine has become widespread in IBD colitis. Here we report a single-centre experience.
Methods
A retrospective review of consecutive patients hospitalised with IBD flare and refractory to intravenous steroid treatment who received rescue infliximab infusion at Aberdeen Royal Infirmary, NHS Grampian, between 2009 and 2017 was performed. Cases were identified using the local biologics IBD database. Patients were followed up for a 1-year period. The project was registered as a service evaluation with the NHS Grampian Clinical Effectiveness team.
Results
In total, 47 patients received infliximab for IBD colitis as a rescue therapy during this period. Median age was 41 years (range 17–87) and 28/47 (59.6%) were female. Twenty-three of 47 (48.9%) patients had a diagnosis of ulcerative colitis (UC) and 19/47 (40.4%) Crohn’s disease (CD), with the remaining unspecified IBD (IBD-U). Three of 47 (6.4%) had a subsequent change in diagnosis. Use in UC has steadily increased since accounting for over half of cases (13/24, 54.2%) since changes to the National Institute of Health and Care guidance in 2015. Primary non-response to infliximab was 12.7%, 4/47 underwent colectomy during the same admission and 2/47 were deemed unfit for surgical intervention. An additional 7/47 (14.9%) required surgery within 1 year of rescue infliximab following discharge. Dosing regimen varied with the majority (30/47, 63.8%) receiving a single dose, with no significant difference in outcome at 1 year from discharge (single dose 3/26, 8.0% vs. 2 or more doses 4/17, 23.5%, p = 0.30). Of the patients undergoing surgery within 1 year, 2 had serious complications following surgery; one anastomotic leak and one mortality due to pulmonary embolism. Three individuals receiving rescue infliximab had infective complications (1 × mild post-operative wound infection, 2 × hospital acquired pneumonia) and one cytomegalovirus colitis following maintenance IFX requiring colectomy. Readmission rate at 1 month for IBD-related issues was 10.6%.
Conclusions
Previous literature has suggested between 17 and 40% of patients have primary non- response to rescue infliximab typically requiring surgery in the same admission and 12 month surgery rates 36%. Our single-centre experience found with appropriate patient selection, acute and longer term surgery rates to be less than reported in current published data. This emphasises the benefits of infliximab in avoiding surgery in the acute setting.