Infliximab versus Cyclosporine Treatment for Severe Corticosteroid-Refractory Ulcerative Colitis: A Korean, Retrospective, Single Center Study

Kim, Eun Hye; Kim, Duk Hwan; Park, Soo Jung; Hong, Sung Pil; Kim, Tae Il; Cheon, Jae Hee

doi:10.5009/gnl14120

Cited by 16 publications

(27 citation statements)

References 33 publications

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“…The studies were published between 2004 and 2018 and the follow-up period ranged at least from 1 year to maximum of 10 years. In the quantitative analysis, we used data from three RCTs (13,18,19) and 12 cohort studies (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). A total number of 1,607 patients with steroid-refractory ASUC were included, 879 of which (54.7%) were treated with CYS and the other 728 (45.3%) with IFX.…”

Section: Characteristics Of the Studies Includedmentioning

confidence: 99%

“…Only two studies reported a single infusion of IFX (20,30). In the IFX treatment groups, AZA was the most commonly administered maintenance drug, albeit recent studies continued IFX (13,23,24,26,28). Due to the lack of available safety data during long-term follow-up in an RCT, the CYSIF trial (18), AE and SAE results reported in the original study were used in the meta-analysis (12).…”

Section: Characteristics Of the Studies Includedmentioning

confidence: 99%

“…Eight studies reported on SAE, such as opportunistic infections, sepsis, anaphylactic reaction and hepato-and nephrotoxicity (Figure 7) (12,13,19,21,24,(26)(27)(28). One hundred and three (15.5%) SAEs were reported with CYS and 72 (15.3%) with IFX.…”

Section: Safetymentioning

confidence: 99%

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Comparable Long-Term Outcomes of Cyclosporine and Infliximab in Patients With Steroid-Refractory Acute Severe Ulcerative Colitis: A Meta-Analysis

et al. 2020

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Background: In steroid-refractory acute severe ulcerative colitis (ASUC), cyclosporine (CYS) or infliximab (IFX) may be considered as a second-line alternative to avoid colectomy. There are short-term data reported, but until now, there is no meta-analysis regarding long-term outcomes of CYS and IFX in patients with ASUC. Aim: To compare long-term efficacy and safety of CYS and IFX in a meta-analysis. Methods: Three electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials) were searched for studies which compared CYS vs. IFX in adults with ASUC. Long-term colectomy-free rate from 1 to 10 years during CYS or IFX therapy was collected, last updated up to 22nd May 2019. Primary outcome was long-term colectomy-free rate, secondary outcomes were adverse events (AE), serious adverse events (SAE), and mortality. Long-term colectomy-free survival and safety measures were pooled with the random-effect model. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. Results: Data from 1,607 patients in 15 trials were extracted. In the first 3 years, pooled OR for colectomy-free survival was higher with IFX than with CYS (OR = 1.59, 95% CI: 1.11-2.29, p = 0.012; OR = 1.57, 95% CI: 1.14-2.18, p = 0.006; and OR = 1.75, 95% CI: 1.08-2.84, p = 0.024; at 1, 2, and 3 years, respectively). However, the significant difference remained undetected from the fourth year of followup and in subgroup of RCTs (OR = 1.35, 95% CI: 0.90-2.01, p = 0.143; OR = 1.41, 95% CI: 0.94-2.12, p = 0.096; and OR = 1.34, 95% CI: 0.89-2.00, p = 0.157; at 1, 2, and 3 years, respectively). No significant difference was detected regarding adverse events, serious adverse events and mortality between the groups. The neutral associations proved to be underpowered with trial sequential analysis. Szemes et al. Steroid-Refractory Acute Severe Ulcerative Colitis Conclusion: However observational studies show IFX as a better choice, according to the RCTs, choosing either CYS or IFX as rescue therapy for ASUC, the long-term outcomes are not different, although further large RCTs are warranted.

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Section: Characteristics Of the Studies Includedmentioning

confidence: 99%

Section: Characteristics Of the Studies Includedmentioning

confidence: 99%

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Comparable Long-Term Outcomes of Cyclosporine and Infliximab in Patients With Steroid-Refractory Acute Severe Ulcerative Colitis: A Meta-Analysis

et al. 2020

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“…However, infliximab with azathioprine may be more effective than ciclosporin alone to avoid colectomy [25]. Table 2 compares the results of our study with those of a recent Spanish study done in 2016 involving 62 patients with severe acute colitis [26]; it shows a high rate of colectomy in our series compared to the Spanish series, and this is due to the unsatisfactory availability of second-line medical treatment which impose us to recourse to colectomy frequently ( Table 2).…”

Section: Monterubbianesi Et Al Reported In a Study Involving 113 Patmentioning

confidence: 40%

Evolutionary Profile of Severe Acute Ulcerative Colitis in Chronic Inflammatory Bowel Diseases

Abid¹,

Babakhouya²,

Mellouki³

et al. 2018

OJGas

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Background: Severe acute colitis is a common complication of inflammatory bowel disease (IBD). Their diagnosis is based on clinical, laboratory, endoscopic and radiological. The severe acute colitis is a medical and surgical emergency; its mortality is 1% to 3%. The management should be swift and coordinated, upon admission, between medical and surgical teams. Methods: This is a retrospective study in Gastroenterology Service at the University Hospital HASSAN II Fez, over a period of 10 years (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015). We included all patients admitted for severe acute colitis; all the epidemiological, clinical, endoscopic, histological, and therapeutic monitoring of patients were collected. Results: We collected 123 patients. Their average age was 35 years (16 -70). It was a female predominance (sex ratio F/M = 1.19). 54 patients were admitted for an inaugural severe acute colitis (43%), while 69 patients were known carriers of IBD (56%). All patients were admitted to an array of severe acute colitis according to the criteria of Truelove and Witts modified. 9 patients were operated urgently because there was the presence of complications (5 cases of perforation, 3 cases of massive rectal bleeding, and one patient with an abscess in the right iliac fossa). Corticosteroids intravenously was administered to 114 patients, 74 patients (64%) had remission. Patients who have not responded to corticosteroids IV (N = 40): 1) 12 patients received treatment with oral cyclosporine: the remission rate was 66%. 2) 8 patients were put under Infliximab: The response rate was 75%. 3) Patients who have not responded to a second-line treatment underwent subtotal colectomy with a dual stoma. 4) The surgery was indicated as a second-line treatment in 20 patients who all received a subtotal colectomy with double stoma; totalizing colectomy and ileoanale anastomosis ware made in 4 patients. The mortality rate is higher in our series (12%) mainly postoperatively; it is due to the delayed admission of patients, which promotes the development of complications. Conclusion: Acute Severe Ulcerative Colitis is a medical and surgical emergency

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“…While no difference was found between the treatments in preventing colectomy, infliximab with azathioprine seemed to be superior to cyclosporine monotherapy when it comes to preventing colectomy. 7 Overall therapeutic response rates of infliximab in Asian IBD patients appeared to be similar or higher than those in patients from Western countries.…”

Section: Introductionmentioning

confidence: 99%

Understanding the complications of anti‐tumor necrosis factor therapy in East Asian patients with inflammatory bowel disease

Cheon

2017

J of Gastro and Hepatol

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Remarkable advances have been made in the treatment of inflammatory bowel disease since the introduction of anti‐tumor necrosis factor‐α agents, especially for patients who are refractory to or cannot tolerate conventional therapies. Currently, infliximab, adalimumab, and golimumab are available in the East Asian medical market, and these agents have been shown to be effective for inducing and maintaining long‐term remission of inflammatory bowel disease. Despite their clinical benefits, anti‐tumor necrosis factor therapy can also lead to increased vulnerability to infections, development of autoimmune diseases and malignancy, and decreased immunogenicity of vaccinations. Because infectious diseases, such as tuberculosis, hepatitis, and influenza, remain major health problems in East Asia, more cautious use of biologics is needed. To further improve treatment efficacy and safety, close monitoring of inflammation, regular surveillance for malignancy, and regularly scheduled vaccinations are needed. Treatment strategies for biologics should be customized to meet the needs of different patients.

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Infliximab versus Cyclosporine Treatment for Severe Corticosteroid-Refractory Ulcerative Colitis: A Korean, Retrospective, Single Center Study

Cited by 16 publications

References 33 publications

Comparable Long-Term Outcomes of Cyclosporine and Infliximab in Patients With Steroid-Refractory Acute Severe Ulcerative Colitis: A Meta-Analysis

Comparable Long-Term Outcomes of Cyclosporine and Infliximab in Patients With Steroid-Refractory Acute Severe Ulcerative Colitis: A Meta-Analysis

Evolutionary Profile of Severe Acute Ulcerative Colitis in Chronic Inflammatory Bowel Diseases

Understanding the complications of anti‐tumor necrosis factor therapy in East Asian patients with inflammatory bowel disease

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