Long-term outcome of patients with acute ulcerative colitis after first course of intravenous corticosteroids

Abstract

Background and aims: Every fifth patient with ulcerative colitis (UC) experiences severe acute flare at some point in the course of the disease. Corticosteroids (Cs) remain the treatment of choice in acute flare. Data on the efficacy of first intravenous Cs in the long-term prognosis of UC are scarce and were investigated here. Materials and methods: All episodes of patients with acute UC admitted to Tampere University Hospital and treated with intravenous Cs between January 2007 and January 2016 were identified from patient records and reviewed. The risks for colectomy and for continuous use of Cs were evaluated. Predictive factors were analysed. Results: The study comprised 217 patients of whom 184 (85%) responded to intravenous Cs at index flare. Of the 33 non-responders, 31 (94%) were treated with intravenous cyclosporine A and 28 responded. Five (2.3%) patients needed emergency colectomy. Twenty-six (12%) patients underwent colectomy within 1 year of index flare. Overall colectomy rate was 56 (26%) during follow-up (median 7.5 years, range 0.1-10.5). Six months after index flare 66 (30%) patients were still on steroids. In this series 149 (69%) required further Cstherapy and 104 (48%) needed rehospitalization for new flare at some point during follow-up. Overall 155 patients were treated with thiopurines, of whom 72% within the first year after admission. A total of 36 patients had infliximab as a first-line biological treatment, nine needed second-line therapy with adalimumab or vedolizumab after infliximab failed. Conclusion: Although intravenous Cs were efficient in inducing clinical response in patients with severe acute UC, only one fifth maintained remission in the long term. Two-thirds of patients required further Cs and the overall colectomy rate remained at 26%. High relapse rate indicates the need for closer monitoring of these patients. Enhancement of maintenance therapy should be considered at early stage after acute flare.

Early management of acute severe UC in the biologics era: development and international validation of a prognostic clinical index to predict steroid response

“…Elsewhere, there are recent studies with similar acute colectomy rates from the UK (14.9%–21.4%),25 52 53 Ireland (18%),54 USA (12.4%),55 Australia (13.3%)56 and Portugal (13.4%) 57. However, overall rates vary widely from 2.8% (6/217) in a Finnish study58 to 75.9% (41/54) in a French study,59 and within countries, there can be substantial variability, such as 7%–76% in France 59 60…”

Contemporary perioperative outcomes after total abdominal colectomy for ulcerative colitis in a tertiary referral centre

“…Despite these advances in medical therapy, colectomy rates remain high, reaching 30% [2] in the overall ulcerative colitis (UC) population, and as high as 30-66% among patients who initially respond to biologics [3,4]. Up to 15% of UC patients will experience acute severe colitis requiring hospitalisation, which carries with it a 7.7-20% same admission colectomy rate [5][6][7].…”

Predictors of adverse outcomes of steroids in patients with severe ulcerative colitis (systematic review and meta-analyses)

“…При этом в течение первого года после манифестации болезни до 40% пациентов могут быть подвергнуты системной терапии кортикостероидами с целью индукции ремиссии [3]. Первичная эффективность лечения кортикостероидами у пациентов с тяжелым ЯК не превышает 70%, а около 40% пациентов сталкиваются с неблагоприятным исходомнеэффективностью гормональной терапии и необходимостью проведения «терапии или хирургии спасения» [4,5]. При этом среди пациентов с тяжелой атакой ЯК, резистентных к гормональной терапии, до 40% могут быть подвергнуты радикальному хирургическому лечению [6].…”