Severe endoscopic lesions are not associated with more infliximab fecal loss in acute severe ulcerative colitis

Abstract

Background: It has been observed that early infliximab (IFX) fecal excretion in patients with acute severe ulcerative colitis (ASUC) was associated with low treatment response.

Aim: The objective was to assess if severe endoscopic lesions (SEL) were associated with IFX loss in the stool as well as low IFX concentrations in plasma at day 1 and 2 in a cohort of patients admitted for ASUC.

Methods: Consecutive patients admitted for a steroid-refractory ASUC requiring IFX and who underwent flexible sigmoidoscopy before starting the drug were included in a case-control, prospective, two-center study. Cases were patients with SEL and controls those without SEL. Plasmatic and fecal IFX concentrations were measured at day 1 and 2.

Results: Among the 15 patients analyzed (10 men; median age: 49 years), 6 were cases harboring SEL at baseline. IFX was detected in the stool in 2/6 (33%) of cases and 4/9 (44%) of controls (p = 1) and no difference was observed between the two groups regarding plasmatic concentrations at day 1 or 2 (p = 1).

Conclusion: In ASUC, SEL were not associated with more loss of IFX in the stool or lower plasmatic levels. Early IFX pharmacokinetics in this setting does not seem related to endoscopic severity.