Journal
EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY
Volume 30, Issue 9, Pages 1019-1026Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MEG.0000000000001177
Keywords
antitumour necrosis factor-alpha therapy; golimumab; inflammatory bowel disease; ulcerative colitis
Categories
Funding
- Investigator Network for Inflammatory bowel disease Therapy in Ireland
- Gastroenterology Departments in St James Hospital
- St Vincent's University Hospital
- Beaumont Hospital
- University Hospital Galway
- Mater Misericordiae University Hospital
- Adelaide and Meath incorporating the National Children's Hospital Tallaght
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Background and aims Golimumab (GLB) is an antitumour necrosis factor-a (anti-TNF) therapy that has shown efficacy as induction and maintenance therapy for ulcerative colitis (UC). We aimed to describe the outcome of GLB therapy for UC in a real-world clinical practice. Patients and methods Consecutive patients receiving GLB for UC in six Irish Academic Medical Centres were identified. The primary study endpoint was the 6-month corticosteroid-free remission rate. The secondary endpoints included the 3-month clinical response, time free of GLB discontinuation and adverse events. Results Seventy-two patients were identified [57% men; median (range) age of 41.4 years (20.3-76.8); disease duration 6.6 years (0-29.9); follow-up 8.7 months (0.4-39.2)]. Sixty-four percent of patients were anti-TNF naive. The 3-month clinical response and the 6-month corticosteroid-free remission rates were 55 and 39%, respectively. Forty-four percent of patients discontinued GLB during the follow-up, median (95% confidence interval) time to GLB discontinuation 18.7 months (9.2-28.1). A C-reactive protein more than 5 mg/l at baseline was associated with failure to achieve 6-month corticosteroid-free remission and a shorter time to GLB discontinuation, odds ratio 0.2 (0.1-0.7), P=0.008, and hazard ratio (95% confidence interval) 2.8 (1.3-5.7), P=0.007, respectively. Adverse events occurred in 7% of patients (n = 5), all of which were minor and self-limiting. Conclusion These real-world clinical data suggest that GLB is an effective and safe therapy for a UC cohort with significant previous anti-TNF exposure. An elevated baseline C-reactive protein, likely reflective of increased inflammatory burden, is associated with a reduced likelihood of a successful outcome of GLB therapy. Copyright (c) 2018 Wolters Kluwer Health, Inc. All rights reserved.
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