Cyclosporine or infliximab as rescue therapy in severe refractory ulcerative colitis: Early and long-term data from a retrospective observational study

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• 作者：Filippo Mocciaro^a ; ^b ; ^{fmocciaro@gmail.com} ; Sara Renna^a ; Ambrogio Orlando^a ; Giulia Rizzuto^a ; Emanuele Sinagra^a ; Emanuele Orlando^c ; Mario Cottone^a
• 关键词：Ulcerative colitis ; Steroid-refractory ; Cyclosporine ; Infliximab ; Colectomy
• 刊名：Journal of Crohn's and Colitis
• 出版年：2012
• 期刊代码：pca215_18739946
• 类别：med
• 出版时间：July, 2012
• 卷：6
• 期：6
• 页码：681-686
• 文件大小：300 K

摘要

Introduction

About 30-40%of patients with acute severe ulcerative colitis (UC) fail to respond to intensive intravenous (iv) corticosteroid treatment. Iv cyclosporine and infliximab are an effective rescue therapy in steroid-refractory UC patients but up to now it is still unclear which is the best therapeutic choice.

Methods

We reviewed our series of severe steroid-refractory colitis admitted consecutively since 1994 comparing two historical cohort treated with iv cyclosporine (2 mg/kg) or iv infliximab (5 mg/kg). The main outcome was the colectomy rate at 3 months, 12 months and at the end of the follow-up.

Results

A total of 65 patients were included: 35 in the cyclosporine group and 30 in the infliximab one. At 3 months the colectomy rate was 28.5%in the cyclosporine group and 17%in the infliximab group (p = 0.25), while 48%versus 17%at 12 months (p = 0.007, OR 4.7; 95%CI: 1.47-15.16). The 1-2-3 year cumulative colectomy rates were 48%, 54%, 57%in the cyclosporine group, and 17%, 23%, 27%in the infliximab group. At the end of the follow-up the colectomy rate was 60%versus 30%(p = 0.04, HR 2.2; 95%CI: 1.11-4.86). High level of C reactive protein (p = 0.04), extensive disease (p = 0.01) and no azathioprine treatment (p < 0.001) were related to the risk of colectomy.

Conclusion

This study, despite being retrospective, indicates that both cyclosporine and infliximab are effective in avoiding a colectomy in steroid-refractory UC patients. During the follow-up the risk of a colectomy is higher in patients treated with cyclosporine than with infliximab.