Infliximab versus cyclosporine for severe ulcerative colitis refractory to steroids

Abstract

Background:Infliximab and cyclosporine are two main therapies in treating acute severe ulcerative colitis (ASUC), our objective is to assess the effectiveness and safety of cyclosporine (CSA) versus infliximab (IFX) as rescue agents in patients with steroid-refractory ulcerative colitis (UC).Methods:We will search three databases from inception to May 2018, and 19 studies are identified that infliximab and cyclosporine as a treatment in steroid-refractory UC patients. The primary outcome was short-term response to treatment. Secondary outcomes included the rates of colectomy at 3 months, 12 months, 36 months, adverse drug reactions and mortality in those who received rescue therapy.Results:This update review will provide a high quality synthesis of current evidence of two treatment for steroid-refractory ulcerative colitis. The definition of severe colitis is according to Truelove and Witts’ criteria.Conclusions:In the treatment of steroid-resistant ulcerative colitis with infliximab and cyclosporine, there is no difference between the two treatments on short-term and long-term results.

Modern principles of severe ulcerative colitis attack therapy: from simple to complex

“…В этом контексте ЦМВ-колит может повлиять на прогноз течения ВЗК и его исходы. При ЯК воспаление слизистой оболочки и Т-хелперные клетки (T H2 цитокина вместе с иммуномодулирующими препаратами, используемыми для контроля обострений, способствуют реактивации вируса в кишечнике, что, в свою очередь, увеличивает воспаление слизистой оболочки толстой кишки, снижает эффективность ГКС и ИС (вероятность резистентности к стероидам увеличивается более чем в 20 раз в случае наличия ЦМВ-колита) и увеличивает риск колэктомии [39].…”

“…В случае выявления у пациента в биоптате из пораженного участка слизистой толстой кишки ДНК цитомегаловируса методом полимеразной цепной реакции пациенту показана терапия ганцикловиром в дозе 5 мг/кг 2 раза в сутки в течение 14-21 дня [39].…”

Esculentoside A could attenuate apoptosis and inflammation in TNBS-induced ulcerative colitis via inhibiting the nuclear translocation of NF-κB

“…Due to its complicated etiology, difficult cure, high recurrence rate, poor prognosis, and increased risk of colon cancer, UC is considered a refractory disease (3,4). Currently, the clinical treatment of UC mainly involves glucocorticoids, 5-aminosalicylic acid, sulfasalazine, mesalazine, and so on, which achieve their therapeutic effect via reducing the intestinal inflammation, promoting intestinal mucosal repair, and improving the intestinal mucosal barrier (5)(6)(7). However, these drug treatments cannot effectively inhibit the development of UC, especially in the prevention of recurrence, and long-term use of these drugs often leads to significant side effects (8).…”