Cyclosporine or infliximab as rescue therapy in severe2 refractory ulcerative colitis: Early and long-term data3 from a retrospective observational study

Mario Cottone, Filippo Mocciaro

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44 Citations (Scopus)

Abstract

Introduction: About 30–40% of patients with acute severe ulcerative colitis (UC) fail to respond23 to intensive intravenous (iv) corticosteroid treatment. Iv cyclosporine and infliximab are an ef-24 fective rescue therapy in steroid-refractory UC patients but up to now it is still unclear which isQ225 the best therapeutic choice in this setting of patients.26 Methods: We reviewed our series of severe steroid-refractory colitis admitted consecutively in27 our referral center since 1994 comparing two historical cohort treated with cyclosporine or28 infliximab. Iv cyclosporine was administered at the dosage of 2 mg/kg and infliximab at the dos-29 age of 5 mg/kg. The main outcome was the colectomy rate at 3 months, 12 months and at the30 end of the follow-up.31 Results: A total of 65 patients were included: 35 in the cyclosporine group and 30 in the inflix-32 imab one. After 3 months from the acute episode the colectomy rate was: 28.5% (10/35) in the33 cyclosporine group and 17% (5/30) in the infliximab group (p=0.25). At 12 months the rate of34 colectomy increased to 48% in the cyclosporine group versus 17% in the infliximab group35 (p=0.007, OR 4.7; 95% CI: 1.47–15.16). The 1–2–3 year cumulative colectomy rates were 48%,36 54%, and 57% in the cyclosporine group, and 17%, 23%, and 27% in the infliximab group. At the37 end of the follow-up the colectomy rate was: 60% in the cyclosporine group and 30% in the inflix-38 imab group (p=0.04, HR 2.2; 95% CI: 1.11–4.86). High level of C reactive protein (p=0.04, OR39 2.9; 95% CI: 1.18–8.28), extensive disease (p=0.01, OR 5.5; 95% CI: 1.57–19.01) and no azathi-40 oprine treatment after the rescue therapy (pb0.001, OR 8.7; 95% CI: 2.49–30.12) were related41 to the risk of colectomy.
Original languageEnglish
Pages (from-to)681-686
Number of pages6
JournalJournal of Crohn's and Colitis
Volume6
Publication statusPublished - 2012

All Science Journal Classification (ASJC) codes

  • Gastroenterology

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