Long-term outcome of infliximab treatment in chronic active ulcerative colitis: a Swedish multicentre study of 250 patients.

BACKGROUND: Real-life long-term data on infliximab treatment in ulcerative colitis are limited. AIM: To study the long-term efficacy and safety of infliximab in chronic active ulcerative colitis and possible predictors of colectomy and response were also examined. METHODS: A retrospective multi-centre study of infliximab treatment in 250 patients with chronic active ulcerative colitis with inclusion criteria: age ≥18 years, ambulatory treated, steroid-dependent or intolerant and/or immunomodulator refractory or intolerant. RESULTS: Steroid-free clinical remission was achieved by 123/250 patients (49.2%) at 12 months and in 126/250 patients at a median follow-up of 2.9 years (50.4%). Primary response at 3 months was achieved by 190/250 (76.0%) patients and associated with a high probability of response 168/190 (88.4%) at 12 months and 143/190 (75.3%) at follow-up. Long-term rate of colectomy in primary responders was 6/190 (3.2%) at 12 months and 27/190 (14.2%) at last follow-up. Failure to achieve response at 3 months was associated with a high risk of subsequent colectomy, 29/60 (48.3%) at 12 months and 41/60 (68.3%) at follow-up. Response at 12 months was associated with a low risk of subsequent colectomy, 14/181 (7.7%) compared with non-response 19/34 (55.9%) (P < 0.0001). Non-response at 3 months was an independent predictor of subsequent colectomy (HR = 9.40, 95% CI = 5.10-17.35, P < 0.001). Concomitant azathioprine therapy did not influence outcome in terms of colectomy. CONCLUSIONS: Long-term efficacy of infliximab treatment in chronic active ulcerative colitis is excellent especially in patients who respond to induction treatment. Conversely, non-response at 3 months predicts a poor outcome, with a high risk of subsequent colectomy.

Food preservative potential of essential oils and fractions from Cymbopogon citratus, Ocimum gratissimum and Thymus vulgaris against mycotoxigenic fungi.

The food preservative potential of essential oils from three aromatic plants Cymbopogon citratus, Ocimum gratissimum and Thymus vulgaris and their fractions was investigated against two mycotoxigenic strains each of Aspergillus ochraceus, Penicillium expansum and P. verrucosum. The fungicidal activity was determined and expressed as a Number of Decimal Reduction of the colony forming units per ml (NDR cfu). The influence of pH variation on this activity was studied. The NDR cfu varied with the essential oils and its concentration, the pH of the medium and the strain tested. The essential oils from O. gratissimum exhibited the highest activity against the six fungal strains under the three pH tested. T. vulgaris and C. citratus essential oils were less active against the Penicillium species tested and A. ochraceus, respectively. Potassium sorbate did not present any activity at pH 6 and 9. At pH 3, its NDR cfu was the lowest against the six fungal strains. At the same pH and at 4000 ppm, the three essential oils presented a NRD cfu > or = 6 against strains of A. ochraceus and P. expansum. The same result was obtained with T. vulgaris and C. citratus at 8000 ppm against both strains of P. verrucosum. The highest activity of the three essential oils was recorded at pH 3 against A. ochraceus strains and at pH 9 against both species of Penicillium. From the fractionation, three active fractions were obtained each from C. citratus and O. gratissimum, and two active fractions from T. vulgaris. These active fractions exhibited a NDR cfu, two to seven folds higher than that of the complete essential oils.