Long-term outcome of patients with steroid-refractory acute severe UC treated with ciclosporin or infliximab

Laharie, David; Bourreille, Arnaud; Branche, Julien; Allez, Matthieu; Bouhnik, Yoram; Filippi, Jérôme; Zerbib, Frank; Savoye, Guillaume; Vuitton, Lucine; Moreau, Jacques; Amiot, Aurélien; Cosnes, Jacques; Ricart, Elena; Dewit, Olivier; López-Sanromán, Antonio; Fuméry, Mathurin; Carbonnel, Franck; Bommelaer, Gilles; Coffin, Benoït; Roblin, Xavier; Assche, Gert Van; Esteve, María; Färkkilä, M.; Gisbert, J.P.; Marteau, Philippe; Nahon, Stéphane; Vos, Martine De; Lambert, Jérôme; Mary, J Y; Louis, Édouard

doi:10.1136/gutjnl-2016-313060

Cited by 127 publications

(103 citation statements)

References 21 publications

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“…We used cyclosporine/infliximab in only 28 of 207 (14%) patients due to prohibitive costs, with similar use in left-sided and extensive colitis (10/74 vs 18/133, P = ns). In addition, in the long-term follow-up of the CYSIF trial, 19 39 of 115 (34%) patients treated with cyclosporine/infliximab underwent a colectomy within a median follow-up of 5 years, which is similar to our results.…”

Section: Discussionsupporting

confidence: 89%

Left‐sided colitis and extensive colitis have similar colectomy rates after index episode of acute severe colitis: A long‐term follow‐up study

et al. 2017

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Background and AimThe extent of disease of ulcerative colitis (UC) has been found to be a predictor of acute severe colitis (ASC), but it is unclear whether the extent of disease at the index episode of ASC is a predictor of long‐term outcome.MethodsHospitalized patients satisfying Truelove and Witts’ criteria under follow‐up at a single center from January 2003 to December 2016 were included. The extent of disease at index ASC was classified according to the Montreal classification as left‐sided or extensive colitis. Extent was used to predict the long‐term risk of colectomy or steroid dependence following an index episode of ASC.ResultsOf 2076 patients with ulcerative colitis, 241 (12%) had an index episode of ASC. In total, 34 (14%) patients underwent a colectomy at index admission and 53 (26%) over a median follow‐up of 48(1–172) months. Left‐sided colitis and extensive colitis did not differ in the rate of colectomy at index admission (12% vs 15%, P = 0.4) and colectomy in follow‐up (31% vs 23%, P = 0.17). Readmission due to ASC was also similar between the two groups (28% vs 32%, P = 0.6).ConclusionExtent of disease at index ASC does not predict colectomy at admission and over the long term.

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Section: Discussionsupporting

confidence: 89%

Left‐sided colitis and extensive colitis have similar colectomy rates after index episode of acute severe colitis: A long‐term follow‐up study

et al. 2017

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“…4,19,20 Thirty-two studies [8][9][10] were extracted from these four reviews, 20 included more than 30 patients. [8][9][10]35,36,[38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] We completed these four systematic reviews by a new PubMed search. We identified 941 citations, of which 844 were excluded, based on the titles or abstracts ( Figure 2).…”

Section: Acute Uc In Population-based Studies (Figure 1)mentioning

confidence: 99%

Systematic review with meta‐analysis: mortality in acute severe ulcerative colitis

Dong

Metzger

Holsbø

et al. 2019

Aliment Pharmacol Ther

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Summary Background Acute severe ulcerative colitis (ASUC) is a life‐threatening condition. Mortality in ASUC decreased in published series but there is uncertainty as to whether this also applies to the real‐life setting. Aim To perform a systematic review and meta‐analysis of mortality in ASUC in studies from referral centres and in population‐based studies, separately and combined. A second aim was to identify risk factors of mortality in ASUC. Methods We searched pubmed and embase from 1998 to 2016, to identify studies that reported 3‐month or 12‐month mortalities of acute UC in adult patients treated in referral centres, and in population‐based studies. Results Six population‐based studies with 741 743 patients and 47 referral centre‐based studies with 2556 patients were included. The pooled 3‐month and 12‐month mortalities were respectively 0.84% and 1.01%. Advanced age was significantly associated with both 3 month and 12 month mortalities (OR = 1.15 per year, 95% CI: 1.10‐1.20 and OR = 1.19 per year, 95% CI: 1.15‐1.23 respectively). The pooled 3‐month and 12‐month mortalities were 0.78% and 0.85% in studies with median age of less than 50 and 2.81% and 4.17% in studies with median age of 50 or more, respectively. After adjustment for age, 3‐month and 12‐month mortalities did not differ between population‐based and referral centre‐based studies. Conclusions Mortality in acute severe ulcerative colitis is approximately 1%; it is higher in older patients. Efforts should be made to improve the care of elderly patients with severe UC.

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“…Most of the studies have focussed on patients refractory to IVS, investigating the efficacy of either anti‐TNF agents or calcineurin inhibitors 7–11 . Indeed, very few studies have reported the long‐term outcome of patients with ASUC responding to IVS, especially with respect to the associated maintenance therapy 12,13 .…”

Section: Introductionmentioning

confidence: 99%

Long‐term outcome of patients with acute severe ulcerative colitis responding to intravenous steroids

Salameh

Kirchgesner

Allez

et al. 2020

Aliment Pharmacol Ther

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Background:The long-term outcome of patients with acute severe ulcerative colitis (ASUC) responding to intravenous steroids (IVS) has been poorly reported. Aims:To assess relapse-free survival in patients with ASUC responding to IVS. Methods:Between January 2006 and December 2017, 142 consecutive patients with ASUC (according to modified Truelove-and-Witts criteria) responding to IVS were included in this multicentre retrospective study. Relapse was defined by a partial Mayo Clinic score >4 and/or the need for another maintenance therapy.Results: Among the 142 included patients (100 naïve of immunomodulator and/or biological agent) hospitalised for ASUC, 59 (41.5%) were treated at discharge with 5-aminosalicylic acid, 60 (42%) with immunomodulators, 18 (13%) with anti-tumour necrosis factor (TNF) agents and 5 (3.5%) with vedolizumab. After a median followup of 4.8 (2.6-7.3) years, 90 (63.4%) had relapsed and 12 (8.5%) had required colectomy. The probabilities of relapse-free survival were 58%, 48% and 40% at 1, 2 and 5 years respectively. The multivariate analysis demonstrated that patients with <6 liquid stools per day at day 3 (hazard ratio 0.56, 95%CI [0.34-0.91]), a partial Mayo Clinic score <2 at day 5 (0.41 [0.21-0.80]) and anti-TNF maintenance therapy (0.37 [0.16-0.87]) were less likely to relapse. The probabilities of colectomy-free survival were 96%, 95% and 91% at 1, 2 and 5 years respectively. Conclusion:Despite a high relapse rate, patients with ASUC responding to IVS had a low rate of colectomy after 5 years of follow-up. Early response to IVS and maintenance therapy with biological agents were associated with a lower rate of relapse. | INTRODUC TI ONUlcerative colitis (UC) is a chronic and disabling disease characterised by a sequence of flares and remission. 1 In up to 25% of cases, patients with UC will develop a severe exacerbation of the disease and require hospitalisation and intravenous steroids (IVS). 2 Acute severe ulcerative colitis (ASUC) is a life-threatening condition with an estimated risk of mortality of 1%-2% and emergency colectomy of 30%. 3,4 Management of ASUC relies on a multidisciplinary approach with gastroenterologists and surgeons and requires hospitalisation for intensive medical therapy. 5 IVS therapy remains the mainstream treatment for patients with ASUC together with fluid and electrolyte resuscitation, nutritional support and thromboprophylaxis. 6Since the 1970s, the effectiveness of this intensive medical therapy has not changed over time, with an overall response rate of 67%. 4

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Long-term outcome of patients with steroid-refractory acute severe UC treated with ciclosporin or infliximab

Abstract: EudraCT: 2006-005299-42; ClinicalTrials.gouv number: NCT00542152; post-results.

Cited by 127 publications

References 21 publications

Left‐sided colitis and extensive colitis have similar colectomy rates after index episode of acute severe colitis: A long‐term follow‐up study

Left‐sided colitis and extensive colitis have similar colectomy rates after index episode of acute severe colitis: A long‐term follow‐up study

Systematic review with meta‐analysis: mortality in acute severe ulcerative colitis

Long‐term outcome of patients with acute severe ulcerative colitis responding to intravenous steroids

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