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World J Gastroenterol. May 7, 2014; 20(17): 4839-4845
Published online May 7, 2014. doi: 10.3748/wjg.v20.i17.4839
Anti-TNF alpha in the treatment of ulcerative colitis: A valid approach for organ-sparing or an expensive option to delay surgery?
Gianluca Rizzo, Daniela Pugliese, Alessandro Armuzzi, Claudio Coco
Gianluca Rizzo, Claudio Coco, Department of Surgical Sciences, Complesso Integrato Columbus, Catholic University of the Sacred Heart, 00168 Rome, Italy
Daniela Pugliese, Alessandro Armuzzi, Internal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University of the Sacred Heart, 00168 Rome, Italy
Author contributions: Rizzo G, Pugliese D, Armuzzi A and Coco C equally participated in the conception, design, analysis, interpretation of data and drafting of this article; all the authors revised the article critically for important intellectual content and gave final approval of the version to be published.
Correspondence to: Gianluca Rizzo, MD, Department of Surgical Sciences, Complesso Integrato Columbus, Catholic University of the Sacred Heart, Via F. Moscati 31-33, 00168 Rome, Italy. gianluca.rizzo1979@libero.it
Telephone: +39-6-3503618-622 Fax: +39-6-3503344
Received: November 1, 2013
Revised: February 6, 2014
Accepted: March 12, 2014
Published online: May 7, 2014
Processing time: 189 Days and 10.8 Hours
Abstract

Ulcerative colitis (UC) is an inflammatory bowel disease affecting large bowel with variable clinical course. The history of disease has been modified by the introduction of biologic therapy, in particular Infliximab (IFX), that has demonstrated efficacy in inducing fast symptoms remission, promoting mucosal healing and maintaining long-term remission. However, surgery is still needed for UC patients: in case of failure of medical therapy and if acute complications or a malignancy occurred. Surgical treatment is associated with a short-term post-operative mortality and morbidity respectively of 0%-4% and 30%. In this study we systematically analyzed: the role of IFX in reducing the colectomy rate, the risk of post-operative morbidity in pre-operatively IFX-treated patients and the cost-effectiveness of IFX therapy. Four of 5 analyzed randomized controlled trials demonstrated that therapy with IFX significantly reduces the colectomy rate. Moreover, pre-operative treatment with IFX doesn’t seem to increase post-operative infectious complications. By an economic point of view, the cost-effectiveness of IFX-therapy was demonstrated for UC patients suffering from moderate to severe UC in a study based on a cost estimation of the National Health Service of England and Wales. However, the argument is debated.

Keywords: Ulcerative colitis; Infliximab; Colectomy; Post-operative complications; Cost-effectiveness; Inflammatory bowel disease

Core tip: The introduction of biologic therapy with Infliximab (IFX) has significantly modified the clinical course of ulcerative colitis. In this study we systematically analyzed the role of IFX in reducing the colectomy rate, the risk of post-operative morbidity in pre-operatively IFX-treated patients and the cost-effectiveness of IFX therapy.