Skip to main content
Erschienen in: Irish Journal of Medical Science (1971 -) 2/2018

29.07.2017 | Original Article

Severe ulcerative colitis: predictors of response and algorithm proposal for rescue therapy

verfasst von: D. G. Ribaldone, I. Dileo, R. Pellicano, A. Resegotti, S. Fagoonee, M. Vernero, G. Saracco, M. Astegiano

Erschienen in: Irish Journal of Medical Science (1971 -) | Ausgabe 2/2018

Einloggen, um Zugang zu erhalten

Abstract

Background

There is no agreeing if rescue therapy can avoid short-term colectomy in patients treated for severe steroid-refractory ulcerative colitis.

Aims

The aim of our study was to identify predictors of response to infliximab and cyclosporine A.

Methods

In this cross-sectional study, 49 patients with severe ulcerative colitis were included. Response to therapy was defined as three or more point reductions in Mayo score after 6 months of treatment and avoidance of colectomy after 1 year. The predictors analysed were gender, age, time from ulcerative colitis diagnosis, months of steroid or/and azathioprine therapy before onset of the severe phase, smoking habits, extension of the disease, laboratory analyses and Mayo score.

Results

Patients treated with infliximab showed a statistically significant higher response rate in case of moderate Mayo score (P = 0.04). Ex-smokers had very low chance of response to infliximab (P = 0.03). In the group treated with cyclosporine A, patients with C-reactive protein >3 mg/L had a response rate significantly higher than those with C-reactive protein <3 mg/L (P = 0.03); those with negative C-reactive protein and moderate Mayo score did not responded to therapy, while in the ones with elevated C-reactive protein and/or severe Mayo score, 15 versus 4 responded (P = 0.008).

Conclusions

Our data suggest that cyclosporine A is advisable in ex-smokers. In never smokers or active smokers, infliximab can be prescribed in case of Mayo score ≤10 and/or negative CRP, while cyclosporine A is indicated in case of Mayo score >10 and positive CRP.
Literatur
1.
Zurück zum Zitat Dignass A, Eliakim R, Magro F et al (2012) European evidence-based consensus on the diagnosis and management of ulcerative colitis part 1: definitions and diagnosis. J Crohns Colitis 6:965–990CrossRefPubMed Dignass A, Eliakim R, Magro F et al (2012) European evidence-based consensus on the diagnosis and management of ulcerative colitis part 1: definitions and diagnosis. J Crohns Colitis 6:965–990CrossRefPubMed
2.
Zurück zum Zitat Peyrin-Biroulet L, Panés J, Sandborn WJ et al (2016) Defining disease severity in inflammatory bowel diseases: current and future directions. Clin Gastroenterol Hepatol 14:348–354.e17CrossRefPubMed Peyrin-Biroulet L, Panés J, Sandborn WJ et al (2016) Defining disease severity in inflammatory bowel diseases: current and future directions. Clin Gastroenterol Hepatol 14:348–354.e17CrossRefPubMed
4.
Zurück zum Zitat Actis GC, Pellicano R (2016) The pathologic galaxy modulating the genotype and phenotype of inflammatory bowel disease: co-morbidity, contiguity, and genetic and epi-genetic factors. Minerva Med 107:401–412PubMed Actis GC, Pellicano R (2016) The pathologic galaxy modulating the genotype and phenotype of inflammatory bowel disease: co-morbidity, contiguity, and genetic and epi-genetic factors. Minerva Med 107:401–412PubMed
5.
Zurück zum Zitat Etchevers MJ, Aceituno M, Garcia-Bosch O et al (2009) Risk factors and characteristics of extent progression in ulcerative colitis. Inflamm Bowel Dis 9:1320–1325CrossRef Etchevers MJ, Aceituno M, Garcia-Bosch O et al (2009) Risk factors and characteristics of extent progression in ulcerative colitis. Inflamm Bowel Dis 9:1320–1325CrossRef
6.
Zurück zum Zitat Tremaine WJ, Sandborn WJ (1999) Practice guidelines for inflammatory bowel disease: an instrument for assessment. Mayo Clin Proc 74:495–501CrossRefPubMed Tremaine WJ, Sandborn WJ (1999) Practice guidelines for inflammatory bowel disease: an instrument for assessment. Mayo Clin Proc 74:495–501CrossRefPubMed
7.
Zurück zum Zitat Travis SP, Stange EF, Lémann M et al (2008) European evidence-based consensus on the management of ulcerative colitis: current management. J Crohns Colitis 2:24–62CrossRefPubMed Travis SP, Stange EF, Lémann M et al (2008) European evidence-based consensus on the management of ulcerative colitis: current management. J Crohns Colitis 2:24–62CrossRefPubMed
8.
Zurück zum Zitat Bennis M, Tiret E (2012) Surgical management of ulcerative colitis. Langenbeck's Arch Surg 397:11–17CrossRef Bennis M, Tiret E (2012) Surgical management of ulcerative colitis. Langenbeck's Arch Surg 397:11–17CrossRef
9.
Zurück zum Zitat Koltun WA (2009) Role of medical rescue therapy in the management of acute severe ulcerative colitis: the surgical perspective. Expert Rev Gastroenterol Hepatol 3:325–327CrossRefPubMed Koltun WA (2009) Role of medical rescue therapy in the management of acute severe ulcerative colitis: the surgical perspective. Expert Rev Gastroenterol Hepatol 3:325–327CrossRefPubMed
10.
Zurück zum Zitat Campbell S, Travis S, Jewell D (2005) CyclosporineA use in acute ulcerative colitis: a long-term experience. Eur I Gastroenterol Hepatol 17:79–84CrossRef Campbell S, Travis S, Jewell D (2005) CyclosporineA use in acute ulcerative colitis: a long-term experience. Eur I Gastroenterol Hepatol 17:79–84CrossRef
11.
Zurück zum Zitat Rutgeerts P, Sandborn WJ, Feagan BG et al (2005) Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med 353:2462–2476CrossRefPubMed Rutgeerts P, Sandborn WJ, Feagan BG et al (2005) Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med 353:2462–2476CrossRefPubMed
12.
Zurück zum Zitat Van Assche G, Vermeire S, Rutgeerts P (2011) Management of acute severe ulcerative colitis. Gut 60:130–133CrossRefPubMed Van Assche G, Vermeire S, Rutgeerts P (2011) Management of acute severe ulcerative colitis. Gut 60:130–133CrossRefPubMed
13.
Zurück zum Zitat Lees CW, Heys D, Ho GT et al (2007) A retrospective analysis of the efficacy and safety of infliximab as rescue therapy in acute severe ulcerative colitis. Aliment Pharmacol Ther 26:411–419CrossRefPubMed Lees CW, Heys D, Ho GT et al (2007) A retrospective analysis of the efficacy and safety of infliximab as rescue therapy in acute severe ulcerative colitis. Aliment Pharmacol Ther 26:411–419CrossRefPubMed
14.
Zurück zum Zitat Mocciaro F, Renna S, Orlando A et al (2012) Cyclosporine A or infliximab as rescue therapy in severe refractory ulcerative colitis: early and long-term data from a retrospective observational study. J Crohns Colitis 6:681–686CrossRefPubMed Mocciaro F, Renna S, Orlando A et al (2012) Cyclosporine A or infliximab as rescue therapy in severe refractory ulcerative colitis: early and long-term data from a retrospective observational study. J Crohns Colitis 6:681–686CrossRefPubMed
15.
Zurück zum Zitat Actis GC, Fadda M, David E et al (2007) Colectomy rate in steroid-refractory colitis initially responsive to cyclosporin: a long-term retrospective cohort study. BMC Gastroenterol 7:13CrossRefPubMedPubMedCentral Actis GC, Fadda M, David E et al (2007) Colectomy rate in steroid-refractory colitis initially responsive to cyclosporin: a long-term retrospective cohort study. BMC Gastroenterol 7:13CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Pinna-Pintor M, Arese P, Bona R et al (2000) Severe steroid-unresponsive ulcerative colitis: outcomes of restorative proctocolectomy in patients undergoing cyclosporin treatment. Dis Colon Rectum 43:609–613CrossRefPubMed Pinna-Pintor M, Arese P, Bona R et al (2000) Severe steroid-unresponsive ulcerative colitis: outcomes of restorative proctocolectomy in patients undergoing cyclosporin treatment. Dis Colon Rectum 43:609–613CrossRefPubMed
17.
18.
Zurück zum Zitat Schroeder KW, Tremaine WJ, Ilstrup DM (1987) Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med 317:1625–1629CrossRefPubMed Schroeder KW, Tremaine WJ, Ilstrup DM (1987) Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med 317:1625–1629CrossRefPubMed
19.
Zurück zum Zitat Subramaniam K, Richardson A, Dodd J et al (2014) Early predictors of colectomy and long-term maintenance of remission in ulcerative colitis patients treated using anti-tumour necrosis factor therapy. Intern Med J 44:464–470CrossRefPubMed Subramaniam K, Richardson A, Dodd J et al (2014) Early predictors of colectomy and long-term maintenance of remission in ulcerative colitis patients treated using anti-tumour necrosis factor therapy. Intern Med J 44:464–470CrossRefPubMed
20.
Zurück zum Zitat Aratari A, Papi C, Clemente V et al (2008) Colectomy rate in acute severe ulcerative colitis in the infliximab era. Dig Liver Dis 40:821–826CrossRefPubMed Aratari A, Papi C, Clemente V et al (2008) Colectomy rate in acute severe ulcerative colitis in the infliximab era. Dig Liver Dis 40:821–826CrossRefPubMed
21.
Zurück zum Zitat Nuij V, Fuhler GM, Edel AJ et al (2015) Benefit of earlier anti-TNF treatment on IBD disease complications? J Crohns Colitis 9:997–1003CrossRefPubMed Nuij V, Fuhler GM, Edel AJ et al (2015) Benefit of earlier anti-TNF treatment on IBD disease complications? J Crohns Colitis 9:997–1003CrossRefPubMed
Metadaten
Titel
Severe ulcerative colitis: predictors of response and algorithm proposal for rescue therapy
verfasst von
D. G. Ribaldone
I. Dileo
R. Pellicano
A. Resegotti
S. Fagoonee
M. Vernero
G. Saracco
M. Astegiano
Publikationsdatum
29.07.2017
Verlag
Springer London
Erschienen in
Irish Journal of Medical Science (1971 -) / Ausgabe 2/2018
Print ISSN: 0021-1265
Elektronische ISSN: 1863-4362
DOI
https://doi.org/10.1007/s11845-017-1666-0

Weitere Artikel der Ausgabe 2/2018

Irish Journal of Medical Science (1971 -) 2/2018 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.