Current therapeutic recommendations: infliximab for ulcerative colitis.

Randomized, controlled studies have shown that infliximab, the chimeric anti-tumor necrosis factor alpha (TNF-alpha) antibody, is effective for the treatment of active and fistulizing Crohn's disease. Because infliximab is beneficial in patients with Crohn's disease, in whom other therapies have failed, it has been postulated that infliximab may also be helpful in patients with ulcerative colitis. Many investigators have studied the effectiveness of infliximab in ulcerative colitis, mainly in patients who are refractory to corticosteroids. Unfortunately, these studies have not yielded a conclusive answer to the efficacy of infliximab in inducing remission in patients with severe ulcerative colitis. However, some have reported excellent results and others less effective, with the overall data being inconclusive. The purpose of this review is to summarize the current literature on the use of infliximab in ulcerative colitis, as well as to provide insight into the possible mechanisms of why it may or may not work in these difficult-to-treat patients.