OBJECTIVES: To assess maintenance treatment patterns of infliximab (IFX) in ulcerative colitis (UC) and the impact of persistence on UC-related hospitalization. METHODS: A retrospective claims analysis using the IMS LifeLink™ Health Plan Claims Database between September 1, 2004 and March 31, 2009 was conducted. The index date was defined as the first claim for IFX between September 1, 2005 and January 1, 2008. Continuous enrollment for 12 months prior and 14 months after the index date was required. Patients were required to have ≥2 claims with an ICD-9 diagnosis code for UC pre-index and be ≥18 years at index. Patients with selected other inflammatory diseases and those undergoing colectomy within 12 weeks of the index date were excluded. Patients with ≥1 infusion following day 56 post index were considered to have maintenance therapy. Hospitalizations were compared to the group of patients with induction infusions only. Within the maintenance treatment group, therapeutic persistence was defined as a medication possession ratio (MPR) of ≥80%; this group was compared to those without therapeutic persistence (<80% MPR). RESULTS: A total of 420 patients were included in the analyses; mean (SD) age = 43.9 (14.1) years; 47.9% female; mean (SD) 6.08 (2.49) IFX infusions; 84.3% (n=354) continued to maintenance therapy. Maintenance patients incurred fewer UC-related hospitalizations (0.12 vs. 0.32), associated costs ($3118 vs. $8610) and had shorter average lengths of stay (ALOS; 8.9 vs. 11.65 days) than induction-only patients. Among maintenance patients, those demonstrating therapeutic persistence (n=202; 57.1%) incurred fewer UC-related hospitalizations (0.03 vs. 0.22) and associated costs ($423 vs. $6678), and had shorter ALOS (6.67 vs. 9.71 days) than those without therapeutic persistence. CONCLUSIONS: Persistent maintenance treatment with IFX is associated with fewer UC-related hospitalizations, lower inpatient costs, and shorter ALOS among patients with UC. Physicians should monitor patients with UC to ensure appropriate IFX maintenance therapy paradigms are followed.