Explore the vast range of titles available.

Background Anti-TNF therapy represented a landmark in medical treatment of ulcerative colitis (UC). There is lack of data on the efficacy and safety of these agents in Brazilian patients. The present study aimed to analyze rates of clinical and endoscopic remission comparatively, between adalimumab (ADA) and infliximab (IFX), in Brazilian patients with UC, and evaluate factors associated with clinical and endoscopic remission after 1 year of treatment. Methods A national retrospective multicenter study (24 centers) was performed including patients with UC treated with anti-TNF therapy. Outcomes as clinical response and remission, endoscopic remission and secondary loss of response were measured in different time points of the follow-up. Baseline predictive factors of clinical and endoscopic remission at week 52 were evaluated using logistic regression model. Indirect comparisons among groups (ADA and IFX) were performed using Student's t, Pearson χ 2 or Fisher's exact test when appropriated, and Kaplan Meier analysis. Results Overall, 393 patients were included (ADA, n = 111; IFX, n = 282). The mean age was 41.86 ± 13.60 years, 61.58% were female, most patients had extensive colitis (62.40%) and 19.39% had previous exposure to a biological agent. Overall, clinical remission rate was 66.78%, 71.62% and 82.82% at weeks 8, 26 and 52, respectively. Remission rates were higher in the IFX group at weeks 26 (75.12% vs. 62.65%, p  < 0.0001) and 52 (65.24% vs. 51.35%, p  < 0.0001) when compared to ADA. According to Kaplan–Meier survival curve loss of response was less frequent in the Infliximab compared to Adalimumab group ( p  = 0.001). Overall, endoscopic remission was observed in 50% of patients at week 26 and in 65.98% at week 52, with no difference between the groups ( p  = 0.114). Colectomy was performed in 23 patients (5.99%). Age, non-prior exposure to biological therapy, use of IFX and endoscopic remission at week 26 were associated with clinical remission after 52 weeks. Variables associated with endoscopic remission were non-prior exposure to biological therapy, and clinical and endoscopic remission at week 26. Conclusions IFX was associated with higher rates of clinical remission after 1 year in comparison to ADA. Non-prior exposure to biological therapy and early response to anti-TNF treatment were associated with higher rates of clinical and endoscopic remission.

The treatment of UC, or simply ulcerative colitis, generally seeks to induce the remission of active disease, maintain remission, prevent complications and provide quality of life to the patient. Patients in mild to moderate activity can be initially treated with sulfasalazine or mesalazine; in general, the doses indicated to induce remission are equivalent to 4 g/day for both drugs. Toxicity appears to be greater with the concomitant use of corticosteroids, and the cessation of this drug is recommended if cyclosporine is introduced. Nevertheless, it should be borne in mind that, if indicated, parenteral nutrition does not have the purpose of inducing remission, as this is not its effect; it aims to maintain the nutritional status of the patient. This is the rationale for maintenance therapy, in addition to improved quality of life and prevention of dysplasia and cancer, which, according to the ECCO consensus, aims to maintain remission without corticosteroids, defined both clinically and endoscopically.