527-533DOI: 10.17235/reed.2015.3804/2015
LUIS FERNÁNDEZ SALAZAR, Jesús Barrio Andrés, Fernando Muñoz, Concepción Muñoz Rosas, Ramón Pajares Villarroya, MONTSERRAT RIVERO TIRADO, Vanessa Prieto Vicente, Jesús Legido Gil, Abdel Bouhmidi, Maite Herranz, Guillermo González Redondo, Nereida Fernández Fernández, fernando santos santamarta, Ramón Sánchez Ocaña, Diana Joao Matias,
Resumen
INTRODUCCIÓN: La intensificación del tratamiento con IFX en la CU es más frecuente de lo establecido en estudios pivotales. OBJETIVOS: Establecer la frecuencia y forma con la que intensificamos en CU en práctica clínica, los factores predictores y comparar la evolución entre los pacientes con tratamiento intensificado y no intensificado. MÉTODOS: Estudio retrospectivo de 10 hospitales y 144 pacientes con respuesta a la inducción con IFX. Se analizaron variables predictoras de la intensificación con análisis de regresión de Cox. Se comparó la evolución, pérdida de respuesta a IFX y colectomía según tratamiento intensificado o no intensificado. RESULTADOS: Tiempo de seguimiento desde la inducción hasta la recogida de datos: 38 meses (RIC 20-62). Tiempo de tratamiento con IFX: 24 meses (RIC 10-44). El 37% de los pacientes requirió intensificación. Se acortó el intervalo en 36 pacientes, se aumentó la dosis en 7, ambas en 10. La introducción simultánea de INM e IFX predijo la intensificación de forma independiente (HR 0,034 p 0,006 IC 0,003-0,371). En los pacientes con tratamiento intensificado fue más frecuente la suspensión de IFX por pérdida de respuesta (30,4% vs 10,2% p 0,002), la reintroducción de corticoides (35% vs 18%, p 0,018) y la colectomía (22% vs 6,4% p 0,011). El 17% de los pacientes intensificados volvió a recibir 5mg/Kg cada 8 semanas. CONCLUSIONES: La intensificación es frecuente y en ocasiones reversible. La introducción del INM en el momento de la inducción con IFX predice la no intensificación. La intensificación, aunque eficaz, se asocia a una peor evolución.
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Bibliografía
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4. Barreiro-de Acosta M, Lorenzo A, Mera J, et al. Mucosal healing and steroid-sparing associated with infliximab for steroid-dependent ulcerative colitis. J Crohns Colitis 2009;3:271-6. DOI: 10.1016/j.crohns.2009.06.003
5. Cesarini M, Katsanos K, Papamichael K, et al. Dose optimization is effective in ulcerative colitis patients losing response to infliximab: A collaborative multicentre retrospective study. Dig Liver Dis 2014;46:135-9. DOI: 10.1016/j.dld.2013.10.007
6. Yamada S, Yoshino T, Matsuura M, et al. Long-term efficacy of infliximab for refractory ulcerative colitis: Results from a single center experience. BMC Gastroenterol 2014;14:80. DOI: 10.1186/1471-230X-14-80
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8. Paul S, Del Tedesco E, Marotte H, et al. Therapeutic drug monitoring of infliximab and mucosal healing in inflammatory bowel disease: A prospective study. Inflamm Bowel Dis 2013;19:2568-76. DOI: 10.1097/MIB.0b013e3182a77b41
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10. Ferrante M, Vermeire S, Fidder H, et al. Long-term outcome after infliximab for refractory ulcerative colitis. J Crohns Colitis 2008;2:219-25. DOI: 10.1016/j.crohns.2008.03.004
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15. Lichtenstein GR, Diamond RH, Wagner CL, et al. Clinical trial: Benefits and risks of immunomodulators and maintenance infliximab for IBD-subgroup analyses across four randomized trials. Aliment Pharmacol Ther 2009;30:210-26. DOI: 10.1111/j.1365-2036.2009.04027.x
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