Efficacy Analysis Of Infliximab In Early Treatment Of Moderate To Severe Ulcerative Colitis

Background and purpose:Ulcerative colitis(UC)is a chronic and recurrent intestinal inflammatory disease whose etiology is not completely clear.The disease mainly involves the rectum,sigmoid colon and even the whole colon.It belongs to the category of inflammatory bowel disease(IBD)with Crohn’s disease(CD).UC is a global disease,with the highest incidence rate in western developed countries.In recent years,there has been a significant increase in UC patients in China,which has become a common and frequently occurring disease.Infliximab(IFX)is an anti-tumor necrosis factor α(TNF-α)Monoclonal antibodies can inhibit TNF-α The inflammatory reactions and tissue damage caused thereby affect the development of the disease,alter the course of the disease,and improve the quality of life of patients.The traditional treatment method for IBD is to gradually use 5-Aminosalicylic acid(5-ASA),glucocorticoids,immunosuppressants based on the severity of the condition.If the effect is not ideal,biological agents are given.Although traditional treatment methods have good therapeutic effects on some IBD patients,there are also many patients who do not respond to non biological therapies such as 5-ASA,glucocorticoids,and immunosuppressants,which may delay the optimal treatment time for some patients,leading to progressive inflammation and irreversible structural intestinal damage.Therefore,an accurate and efficient treatment plan is very important for IBD patients to achieve treatment goals,and a safe and effective biological treatment plan is needed to change the course of moderate to severe UC and CD,and improve the quality of life of patients.Early initiation of biological agents in moderate to severe diseases may achieve the best therapeutic effect before conventional treatment fails.Previous studies have shown that early combination of immunosuppressants and biologics in CD patients can alleviate their condition faster than traditional step-up therapy.However,there is currently insufficient evidence to support whether early application of biological agents can improve the remission rate of UC and improve the prognosis of UC patients.This article explores the effectiveness and safety of early application of IFX in the treatment of moderate to severe UC.Methods:Retrospective analysis of the clinical data of 56 patients with moderate to severe UC who were hospitalized in the Department of Gastroenterology at the China-Japan United Hospital of Jilin University from January 2019 to February 2023 and initially treated with IFX.Compare the clinical response rate,endoscopic response rate,and incidence of adverse reactions at 14 and 30 weeks using IFX treatment in the early(Time from initial application of infliximab to initial diagnosis<2 years)and late(Time from initial application of infliximab to initial diagnosis ≥2 years)stages.Regression analysis of the impact of applying IFX at different stages and other factors on disease remission.The data was analyzed using SPSS 26.0software,and P<0.05 indicates a statistically significant difference.Result:1.A total of 56 patients with moderate to severe UC who received infliximab for the first time were included,including 32 patients in the early treatment group and 24 patients in the late treatment group.The average age of the early treatment group was 37.53 ± 15.09 years,and the time between the initial application of infliximab and the first diagnosis was 0.59(0.17,1.00)years.The average age of the advanced treatment group was 43.58 ± 11.75 years old,and the time between the initial application of infliximab and the first diagnosis was 6.50(3.00,10.00)years.2.At the 14 th week of application of infliximab,the clinical and endoscopic response rates of patients in the early treatment group were similar to those in the late treatment group(P>0.05).At 30 weeks,the clinical response rate and endoscopic response rate of patients in the early treatment group were significantly higher than those in the late treatment group(clinical response rate 84.3% vs 58.3%,endoscopic response rate 68.8% vs 41.7%),and the difference was statistically significant(P<0.05).3.Logistic regression analysis found that early treatment and high baseline HB levels significantly improved the clinical response rate of patients at 30 weeks(P<0.05).Early treatment and high baseline CRP levels can significantly improve the endoscopic response rate of patients at 30 weeks(P<0.05).4.The total incidence of adverse reactions in all 56 patients was 23.2%,including infusion reaction rate of 7.1%,respiratory infection rate of 7.1%,intestinal infection rate of 5.4%,and liver function damage rate of 3.6%.The total incidence of adverse reactions in the early treatment group was 18.8%,while the total incidence of adverse reactions in the late treatment group was 29.2%.There was no statistically significant difference between the two groups(P>0.05).Conclusion:1.In patients with moderate to severe UC,the early application of infliximab during the course of the disease can achieve better therapeutic effects compared to the late application.2.In patients with moderate to severe UC,the adverse reactions in the early infliximab treatment group were similar to those in the late treatment group.