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J Crohns Colitis. 2014 Nov;8(11):1427-37. doi: 10.1016/j.crohns.2014.05.004. Epub 2014 Jun 5.

The effectiveness and safety of rescue treatments in 108 patients with steroid-refractory ulcerative colitis with sequential rescue therapies in a subgroup of patients.

Author information

1
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.
2
Department of Gastroenterology, Spital Tiefenau, Tiefenaustrasse 112, 3004 Bern, Switzerland; Department of Gastroenterology, Inselspital, University Hospital Bern, Switzerland. Electronic address: Frank.Seibold@spitalnetzbern.ch.
3
Department of Gastroenterology and Hepatology, University Hospital Lausanne, Lausanne, Switzerland. Electronic address: alain.schoepfer@chuv.ch.
4
Department of Statistics, Faculty of Organizational Sciences, Belgrade, Serbia. Electronic address: zoran@fon.rs.
5
Department of Gastroenterology, Inselspital, University Hospital Bern, Switzerland. Electronic address: pascal.juillerat@insel.ch.
6
Department of Gastroenterology, University Hospital Zvezdara, Belgrade, Serbia. Electronic address: 8411112@telenormail.rs.
7
Division of Clinical Pharmacology and Toxicology, University Hospital Zürich, Zürich, Switzerland. Electronic address: jessica.mwinyi@usz.ch.
8
Department of Gastroenterology, Hospital Neuchâtel, Neuchâtel, Switzerland. Electronic address: christian.mottet@h-ne.ch.
9
Department of Gastroenterology, University Hospital Zvezdara, Belgrade, Serbia. Electronic address: ibd@eunet.rs.
10
Department of Gastroenterology, University Hospital Basel, Basel, Switzerland. Electronic address: beglinger@tmr.ch.
11
Department of Gastroenterology and Hepatology, Stadtspital Triemli, Zürich, Switzerland. Electronic address: stephan.vavricka@triemli.stzh.ch.
12
Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland. Electronic address: gerhard.rogler@usz.ch.
13
Department of Gastroenterology, See Spital, Horgen, Switzerland. Electronic address: pascal.frei@see-spital.ch.

Abstract

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.

KEYWORDS:

Ciclosporin; Inflammatory bowel disease; Infliximab; Tacrolimus; Ulcerative colitis

PMID:
24908178
DOI:
10.1016/j.crohns.2014.05.004
[Indexed for MEDLINE]
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