Who should be treated with infliximab during a severe Colitis flare-up?

What this research looked at

Acute Severe Ulcerative Colitis (ASUC) is a life-threatening condition that needs urgent treatment. But 4 in 10 people with ASUC do not respond to steroid treatment. They need further rescue treatment with infliximab or cyclosporin. Some people do not respond to infliximab either. They will then need emergency surgery to remove their bowel, called a colectomy. Emergency surgery is riskier than planned surgery.

People with ASUC process infliximab differently to people with less severe Colitis.

This is because: 

• There is more inflammation in ASUC. This acts as a sponge to soak up the infliximab and clear it from the body more quickly. 
• Severe inflammation makes the large bowel leakier. This means more infliximab leaves the body in poo. 
• Infliximab needs to bind to a protein in the blood called albumin. People with ASUC have less albumin in their blood. 

This project looked at how infliximab interacts with the body in people with ASUC. The researchers wanted to find the right level of infliximab the body needs to make sure ASUC treatment is successful.

What the researchers found

The researchers took blood and poo samples from people with ASUC who had infliximab treatment. They took samples at different times after treatment. They measured the amount of infliximab in these samples. These samples showed the researchers how quickly infliximab was removed from the body.

They also monitored symptoms and measured inflammation in the people with ASUC. They tried to match infliximab levels to treatment success in ASUC.

The researchers found a link between the levels of infliximab in the body in the first days after treatment and the response to treatment. They think that people with ASUC remove infliximab from their body quicker than those with less severe Colitis.

What the researchers think this could mean for people with Crohn's and Colitis 

The researchers are going to use the data from this project in further work. They want to personalise the treatment of ASUC. This would mean that each individual patient gets the right dose of infliximab to treat them. This will lead to better outcomes for people with ASUC.

Who is leading this research: Dr Sree Subramanian, Royal Liverpool and Broadgreen University Hospitals NHS Trust 
Our funding: £87,164 
Duration: 36 months 
Official title of application: Investigation of infliximab pharmacokinetics in acute severe Ulcerative Colitis (ASUC)