Incidence of Colectomy During Long-term Follow-up After Cyclosporine-Induced Remission of Severe Ulcerative Colitis

Moskovitz, David N.; Assche, Gert Van; Maenhout, Benedikte; Arts, Joris; Ferrante, Marc; Vermeire, Séverine; Rutgeerts, Paul

doi:10.1016/j.cgh.2006.04.001

Cited by 271 publications

(213 citation statements)

References 16 publications

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“…Th e rate of colectomy in those already on azathioprine compared with those starting azathioprine concurrently with CSA was 59 % vs. 31 % , respectively. Life-table analysis showed that although only 33 % of patients required colectomy at 1 year, 88 % required colectomy at 7 years ( 274 ).…”

Section: The Patient With Severe Colitis Refractory To Maximal Oral Tmentioning

confidence: 99%

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

1,154

977

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Guidelines for clinical practice are aimed to indicate preferred approaches to medical problems as established by scientifi cally valid research. Double-blind placebo controlled studies are preferable, but compassionate-use reports and expert review articles are used in a thorough review of the literature conducted through Medline with the National Library of Medicine. When only data that will not withstand objective scrutiny are available, a recommendation is identifi ed as a consensus of experts. Guidelines are applicable to all physicians who address the subject regardless of specialty training or interests and are aimed to indicate the preferable but not necessarily the only acceptable approach to a specifi c problem. Guidelines are intended to be fl exible and must be distinguished from standards of care, which are infl exible and rarely violated. Given the wide range of specifi cs in any healthcare problem, the physician must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the board of trustees. Each has been intensely reviewed and revised by the Committee, other experts in the fi eld, physicians who will use them, and specialists in the science of decision analysis. The recommendations of each guideline are therefore considered valid at the time of composition based on the data available. New developments in medical research and practice pertinent to each guideline will be reviewed at a time established and indicated at publication to assure continued validity. The recommendations made are based on the level of evidence found. Grade A recommendations imply that there is consistent level 1 evidence (randomized controlled trials), grade B indicates that the evidence would be level 2 or 3, which are cohort studies or case -control studies. Grade C recommendations are based on level 4 studies, meaning case series or poor-quality cohort studies, and grade D recommendations are based on level 5 evidence, meaning expert opinion.

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Section: The Patient With Severe Colitis Refractory To Maximal Oral Tmentioning

confidence: 99%

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

1,154

977

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“…7 The initial response rate to ciclosporin reported in clinical trials is 64-86%, however long-term outcomes are significantly poorer, with observational studies suggesting colectomy rates of 38-88% at up to seven years in initial responders. [8][9][10][11][12][13] In patients who respond to intravenous ciclosporin, therapy is transitioned to oral ciclosporin (5 mg/kg) after 5-7 days. A thiopurine can be started concurrently with oral ciclosporin, with the aim of discontinuing ciclosporin by 3-6 months.…”

Section: Assessing Response To Medical Treatmentmentioning

confidence: 99%

Management of acute severe ulcerative colitis (NICE CG 166)

Macken

Blaker

2015

Clinical Medicine

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Ulcerative colitis (UC) presents as an acute severe flare in 10-15% of new cases and it occurs in 15% of patients with established disease. Acute severe UC can lead to significant morbidity and mortality in predominantly younger patients without other comorbidities. Inpatient hospital admission and a multidisciplinary approach are vital in appropriate and timely management. Important but simple aspects in the initial work-up and treatment of such patients are frequently overlooked during the acute medical take. An overview of the general and more specialist management of this important presentation are discussed herein.

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“…The use of intravenous cyclosporine (CsA) has been well described as an effective rescue therapy in up to 80% of acute severe steroid-refractory UC patients [29,30] . The intravenous therapy is then followed by oral CsA for a period of 3 mo while the patients are transitioned onto long-term immunomodulator therapy with AZA/6MP [31] .…”

Section: Cyclosporine Enemasmentioning

confidence: 99%

“…The intravenous therapy is then followed by oral CsA for a period of 3 mo while the patients are transitioned onto long-term immunomodulator therapy with AZA/6MP [31] . Despite the use of these agents, however, many patients will relapse and require colectomy within 12 mo [30,32,33] . Concerns over the safety profile of CsA, even at a low oral dose [34] has, however, resulted in a reluctance for some clinicians to use this medication.…”

Section: Cyclosporine Enemasmentioning

confidence: 99%

Novel topical therapies for distal colitis

Lawrance¹

2010

WJGPT

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Distal colitis (DC) can be effectively treated with topical 5ASA agents. Suppositories target the rectum while enemas can reliably reach the splenic flexure. Used in combination with oral 5ASAs, the control of the inflamm ation is even more effective. Unfortunately, resistant DC does occur and can be extremely challenging to manage. In these patients, the use of steroids, immu nosuppressants and the antitumor necrosis factor α agents are often required. These, however, can be associated with systemic side effects and are not always effective. The investigation of new topical therapeutic agents is thus required as they are rarely associated with significant blood drug levels and side effects are infrequent. Some of the agents that have been proposed for use in resistant distal colitis include butyrate, cycl osporine and nicotine enemas as well as tacrolimus suppositories and tacrolimus, ecabet sodium, arsenic, lidocaine, rebamipide and Ridogrel ® enemas. Some of these agents have demonstrated impressive results but the majority of the agents have only been assessed in small openlabelled patient cohorts. Further work is thus required with the investigation of promising agents in the context of randomized doubleblinded placebo controlled trials. This review aims to highlight those potentially ef fective therapies in the management of resistant distal colitis and to promote interest in furthering their investi gation.

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Incidence of Colectomy During Long-term Follow-up After Cyclosporine-Induced Remission of Severe Ulcerative Colitis

Cited by 271 publications

References 16 publications

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Management of acute severe ulcerative colitis (NICE CG 166)

Novel topical therapies for distal colitis

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