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Canadian Journal of Gastroenterology
Volume 17 (2003), Issue 3, Pages 198-200
http://dx.doi.org/10.1155/2003/470210
Brief Communication

Infliximab Salvage Therapy after Cyclosporine in an Acute Flare of Chronic Ulcerative Colitis

ECS Lam1 and RJ Bailey2

1Department of Medicine, University of Alberta, Canada
2Department of Medicine, Royal Alexandra Hospital, Edmonton, Alberta, Canada

Received 9 September 2002; Revised 16 January 2003

Copyright © 2003 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Although infliximab (Remicade, Schering Canada Inc, Quebec) therapy has been well studied in steroid refractory Crohn’s disease, its use remains controversial in chronic ulcerative colitis. A 24-year-old woman with a 14-year history of well controlled left sided ulcerative colitis presented with an acute flare. Clinical, endoscopic and biopsy evidence of an acute flare of ulcerative pancolitis were present. There was no response to intravenous steroids but improvement was seen after receiving 14 days of intravenous cyclosporine (4 mg/kg/day continuous infusion). The patient was discharged from hospital with azathioprine (2.5 mg/kg/day) and low dose oral cyclosporine (4 mg/kg/day). She presented with worsening symptoms seven days after discharge. Because of the patient’s unwillingness for surgery, she instead received two injections of infliximab 5 mg/kg at week 0 and week 2. An initial response occurred, but her clinical improvement was not durable. Colectomy was performed four weeks later. This is the first report of infliximab as a salvage therapy in an acute flare of chronic ulcerative colitis following failure of cyclosporine.