The effectiveness and safety of rescue treatments in 108 patients with steroid-refractory ulcerative colitis with sequential rescue therapies in a subgroup of patients.
- Protic M Department of Gastroenterology, Spital Tiefenau, Tiefenaustrasse 112, 3004 Bern, Switzerland; Division of Clinical Pharmacology and Toxicology, University Hospital Zürich, Zürich, Switzerland. Electronic address: marijana.n.protic@gmail.com.
- Seibold F Department of Gastroenterology, Spital Tiefenau, Tiefenaustrasse 112, 3004 Bern, Switzerland; Department of Gastroenterology, Inselspital, University Hospital Bern, Switzerland. Electronic address: Frank.Seibold@spitalnetzbern.ch.
- Schoepfer A Department of Gastroenterology and Hepatology, University Hospital Lausanne, Lausanne, Switzerland. Electronic address: alain.schoepfer@chuv.ch.
- Radojicic Z Department of Statistics, Faculty of Organizational Sciences, Belgrade, Serbia. Electronic address: zoran@fon.rs.
- Juillerat P Department of Gastroenterology, Inselspital, University Hospital Bern, Switzerland. Electronic address: pascal.juillerat@insel.ch.
- Bojic D Department of Gastroenterology, University Hospital Zvezdara, Belgrade, Serbia. Electronic address: 8411112@telenormail.rs.
- Mwinyi J Division of Clinical Pharmacology and Toxicology, University Hospital Zürich, Zürich, Switzerland. Electronic address: jessica.mwinyi@usz.ch.
- Mottet C Department of Gastroenterology, Hospital Neuchâtel, Neuchâtel, Switzerland. Electronic address: christian.mottet@h-ne.ch.
- Jojic N Department of Gastroenterology, University Hospital Zvezdara, Belgrade, Serbia. Electronic address: ibd@eunet.rs.
- Beglinger C Department of Gastroenterology, University Hospital Basel, Basel, Switzerland. Electronic address: beglinger@tmr.ch.
- Vavricka S Department of Gastroenterology and Hepatology, Stadtspital Triemli, Zürich, Switzerland. Electronic address: stephan.vavricka@triemli.stzh.ch.
- Rogler G Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland. Electronic address: gerhard.rogler@usz.ch.
- Frei P Department of Gastroenterology, See Spital, Horgen, Switzerland. Electronic address: pascal.frei@see-spital.ch.
- 2014-06-09
Published in:
- Journal of Crohn's & colitis. - 2014
Ciclosporin
Inflammatory bowel disease
Infliximab
Tacrolimus
Ulcerative colitis
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Inflammatory Agents, Non-Steroidal
Antibodies, Monoclonal
Colectomy
Colitis, Ulcerative
Cyclosporine
Drug Therapy, Combination
Female
Humans
Immunosuppressive Agents
Infliximab
Male
Middle Aged
Retreatment
Retrospective Studies
Salvage Therapy
Severity of Illness Index
Steroids
Tacrolimus
Treatment Failure
Young Adult
English
BACKGROUND
Among patients with steroid-refractory ulcerative colitis (UC) in whom a first rescue therapy has failed, a second line salvage treatment can be considered to avoid colectomy.
AIM
To evaluate the efficacy and safety of second or third line rescue therapy over a one-year period.
METHODS
Response to single or sequential rescue treatments with infliximab (5mg/kg intravenously (iv) at week 0, 2, 6 and then every 8weeks), ciclosporin (iv 2mg/kg/daily and then oral 5mg/kg/daily) or tacrolimus (0.05mg/kg divided in 2 doses) in steroid-refractory moderate to severe UC patients from 7 Swiss and 1 Serbian tertiary IBD centers was retrospectively studied. The primary endpoint was the one year colectomy rate.
RESULTS
60% of patients responded to the first rescue therapy, 10% went to colectomy and 30% non-responders were switched to a 2(nd) line rescue treatment. 66% of patients responded to the 2(nd) line treatment whereas 34% failed, of which 15% went to colectomy and 19% received a 3(rd) line rescue treatment. Among those, 50% patients went to colectomy. Overall colectomy rate of the whole cohort was 18%. Steroid-free remission rate was 39%. The adverse event rates were 33%, 37.5% and 30% for the first, second and third line treatment respectively.
CONCLUSION
Our data show that medical intervention even with 2(nd) and 3(rd) rescue treatments decreased colectomy frequency within one year of follow up. A longer follow-up will be necessary to investigate whether sequential therapy will only postpone colectomy and what percentage of patients will remain in long-term remission.
Among patients with steroid-refractory ulcerative colitis (UC) in whom a first rescue therapy has failed, a second line salvage treatment can be considered to avoid colectomy.
AIM
To evaluate the efficacy and safety of second or third line rescue therapy over a one-year period.
METHODS
Response to single or sequential rescue treatments with infliximab (5mg/kg intravenously (iv) at week 0, 2, 6 and then every 8weeks), ciclosporin (iv 2mg/kg/daily and then oral 5mg/kg/daily) or tacrolimus (0.05mg/kg divided in 2 doses) in steroid-refractory moderate to severe UC patients from 7 Swiss and 1 Serbian tertiary IBD centers was retrospectively studied. The primary endpoint was the one year colectomy rate.
RESULTS
60% of patients responded to the first rescue therapy, 10% went to colectomy and 30% non-responders were switched to a 2(nd) line rescue treatment. 66% of patients responded to the 2(nd) line treatment whereas 34% failed, of which 15% went to colectomy and 19% received a 3(rd) line rescue treatment. Among those, 50% patients went to colectomy. Overall colectomy rate of the whole cohort was 18%. Steroid-free remission rate was 39%. The adverse event rates were 33%, 37.5% and 30% for the first, second and third line treatment respectively.
CONCLUSION
Our data show that medical intervention even with 2(nd) and 3(rd) rescue treatments decreased colectomy frequency within one year of follow up. A longer follow-up will be necessary to investigate whether sequential therapy will only postpone colectomy and what percentage of patients will remain in long-term remission.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.crohns.2014.05.004
- PMID 24908178
- Persistent URL
- https://sonar.ch/global/documents/183312
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