Is infliximab effective in decreasing symptoms in patients with ulcerative colitis?

Infliximab is effective in patients with moderate to severe ulcerative colitis, as well as in patients with Crohn's disease. Approximately half the patients will achieve long-term symptom reduction, and approximately 40% will achieve long-term remission. (LOE = 1a-)

Gisbert JP, Gonzalez-Lama Y, Mate J. Systematic review: infliximab therapy in ulcerative colitis. Aliment Pharmacol Ther 2006;25:19-37.  [PMID:17229218]

Meta-analysis (randomized controlled trials)

Government

Various (meta-analysis)

Infliximab is a monoclonal antibody directed against tumor necrosis factor-alpha and is used in the treatment of active Crohn's disease. The Spanish researchers performing this meta-analysis identified 34 studies enrolling a total of 896 patients with ulcerative colitis. Methods for determining study inclusion and for data abstraction were not described. The authors found the articles by searching 5 databases for randomized trials comparing infliximab with either placebo or steroids. Approximately 64% of patients in the included studies had severe disease, 52% were steroid-resistant, and approximately 46% were also receiving immunosuppressant therapy. All the studies were of high quality. Two weeks following treatment, 68% of patients, on average, responded (95% CI, 65-71%) and 40% achieved remission (36% - 44%). At 9 months, approximately 50% responded and remission occurred in 39% (number needed to treat = 3 - 5). Adverse effects reports are frequent with both infliximab and placebo, though greater with infliximab (number needed to treat to harm = 14).