Does Anti-TNF Therapy Reduce the Requirement for Surgery in Ulcerative Colitis? A Systematic Review
Jerome Filippi, Patrick B. Allen, Xavier Hebuterne and Laurent Peyrin-Biroulet
Affiliation: Department of Gastroenterology, University Hospital of Nancy, Henri Poincare University, Nancy 1, Allee du Morvan, 54 511 Vandoeuvre-les-Nancy, France.
Infliximab has demonstrated its efficacy in moderate to severe ulcerative colitis. The Active Ulcerative Colitis Trial (ACT) -1 and 2 have demonstrated the beneficial impact of infliximab on the short-term colectomy rate. However, data evaluating this outcome beyond one year remains scarce. To provide evidence on the potential impact of infliximab on the long-term colectomy rate in patients suffering from ulcerative colitis, data was reviewed from randomized and controlled studies, referral center studies and population-based studies, in adult and pediatric populations. In the prebiologic era, 9-33%, 50% and 29% of adult patients with ulcerative colitis underwent colectomy in clinical trials, referral center studies and population-based cohorts, respectively. In the pediatric population, 9-61% and 8-20% underwent colectomy in referral centers and population-based cohorts, respectively. Between 10 and 36% of adult patients treated with infliximab for ulcerative colitis underwent colectomy in clinical trials, referral center studies and population-based cohorts. In the pediatric population treated with infliximab, long-term data is lacking, with colectomy rates ranging from 16 to 28%. Whether infliximab proves to be a disease modifying treatment in ulcerative colitis in the long term remains to be elucidated and will require further long-term prospective studies.
Keywords: Colectomy, Ulcerative Colitis, Inflixamab, Adalimumab, Tumor Necrosis Factor, ACT 1, ACT 2
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