Predictive Factors of Response to Cyclosporine in Steroid-Refractory Ulcerative Colitis

Cacheux, Wulfran; Seksik, Philippe; Lémann, Marc; Marteau, Philippe; Nion–Larmurier, Isabelle; Afchain, Pauline; Daniel, Fady; Beaugerie, Laurent; Cosnes, Jacques

doi:10.1111/j.1572-0241.2007.01653.x

Cited by 95 publications

(67 citation statements)

References 27 publications

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“…In this study, the disease extent (10-13), disease duration (14,15), gender (16,17) and endoscopic findings (14,15,18,19) were not significant predictive factors for a colectomy as well as CNI non-responsiveness, although previous reports have identified these factors to predict the outcome. Most of these previous reports investigated the prognostic factors of patients treated with corticosteroids.…”

Section: Discussionmentioning

confidence: 41%

Prognostic factors for colectomy in refractory ulcerative colitis treated with calcineurin inhibitors

Bamba

Andoh

Imaeda

et al. 2012

Experimental and Therapeutic Medicine

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Abstract. Calcineurin inhibitors (CNIs) such as cyclosporin A (CSA) and tacrolimus (FK506) are efficacious in patients with steroid-refractory or steroid-dependent ulcerative colitis (UC). We retrospectively investigated patients with refractory UC treated with CNIs to elucidate the prognostic factors for a colectomy. Data from 59 patients (35 men and 24 women) were analyzed. CSA and FK506 were administered by intravenous infusion and peroral administration, respectively. The efficacy of the CNIs was assessed using Seo's complex integrated disease activity index. Categorical data analyses were also conducted. The results revealed that the response rates for CSA and FK506 were similar (CSA, 66.6%; FK506, 63.6%). However, oral FK506 had a slower onset of action than intravenous CSA. The risk factors for CNI non-responsiveness were: i) more than 10,000 mg of prednisolone used prior to CNI treatment; and ii) positivity for cytomegalovirus antigenemia (C7-HRP). The factors affecting the rate of colectomy were: i) CNI non-responsiveness; ii) more than 10,000 mg of prednisolone used prior to the initiation of CNI treatment; and iii) positivity for C7-HRP. The addition of azathioprine (AZA) following CNI treatment significantly reduced the incidence of colectomy. Our results revealed the prognostic factors affecting the efficacy of CNI therapy and the need for colectomy in patients with refractory UC. Importantly, some of these factors may be obtained prior to or shortly following the start of CNI treatment. Furthermore, AZA is an important agent for averting colectomy once a patient responds to CNIs.

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Section: Discussionmentioning

confidence: 41%

Prognostic factors for colectomy in refractory ulcerative colitis treated with calcineurin inhibitors

Bamba

Andoh

Imaeda

et al. 2012

Experimental and Therapeutic Medicine

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“…Additional randomized controlled trials showed similar effi cacy with an intravenous CSA dose of 2 mg / kg per day (275) , and CSA 2 mg / kg per day was as eff ective as hydrocortisone intravenously ( 276 ). Predictive factors for failure to respond to CSA include persistent fevers, tachycardia, elevated C-reactive protein, hypoalbuminemia, and deep colonic ulcerations ( 277,278 ).…”

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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“…The former two parameters have been identified as predictive factors by previous studies. 6,8,9 The authors use these factors to propose a novel calculation formula and a decision tree analysis, which predicts colectomy with an accuracy of 90.4%, positive predictive value of 72.2% and negative predictive value of 100%. Most patients included in the study had disease refractory to other agents including one patient previously treated with tacrolimus and two patients having received infliximab induction therapy.…”

Section: -10mentioning

confidence: 99%

“…3,4 There have been some reports of switching from ciclosporin to infliximab and vice versa if one treatment is not effective for acute severe ulcerative colitis. [5][6][7][8] However, higher rates of adverse events and mortality due to long-term stronger immunosuppression have warned that administering the sequential therapy should be carefully decided on an individual basis. The establishment of prediction formulae for the efficacy of…”

Section: -10mentioning

confidence: 99%

Commentary: predicting response to ciclosporin in acute severe ulcerative colitis

Peake

Hart

2012

Aliment Pharmacol Ther

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We read with interest the commentary of Dr Howden regarding our paper describing the effect of proton pump inhibitors (PPIs) on serious infections in cirrhotic veterans.1, 2 There are several important points raised in this letter that highlight the controversial nature of this topic. The hazard ratios were arrived at after controlling for several factors that can affect infection risk, i.e. age, co-morbidities, concurrent medications, alcoholic aetiology and prior hospitalisations in our advanced cirrhotic population. 3 We still found a significant increase in the rate, 1.66, i.e. 66% increase for all infections and 1.75, 75% increase for acid-suppression infections. We argue that this is clinically significant for this population, which has an extremely high mortality from infections compared with non-infected cirrhotics and noncirrhotic infected patients. 4 This increased rate gains higher importance, given that we only restricted ourselves to those who initiated PPI after decompensation, to infections associated with hospitalisation and to those patients whose exact PPI doses could be tracked. Although we agree that pneumonia, as well as other infections, has risk factors other than acid-suppression, we found an overall increase in risk of all infections in those who initiated PPI, just that it was higher for those with acid suppression-related infections. We do agree that re-evaluation of the indication for PPI use is important as prior studies demonstrate that a significant percentage of cirrhotic patients receive PPI therapy for unknown indications. 5, 6 However, this dataset did not allow us to analyse indications. Given the poor survival in decompensated cirrhotics with infections, any modifiable factor that can reduce this risk including, but not limited to, reassessing nonindicated PPI use, is worth investigating and acting upon. Therefore, we believe that these findings do not overstate the risk of infections with PPI initiation, given the controlled nature of the analysis. ACKNOWLEDGEMENTThe authors' declarations of personal and financial interests are unchanged from those in the original article.

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Predictive Factors of Response to Cyclosporine in Steroid-Refractory Ulcerative Colitis

Abstract: In patients with steroid-refractory UC, the combination of simple criteria is useful to predict the response to cyclosporine. Colonoscopy is crucial in patients with intermediate clinical and biological severity.

Cited by 95 publications

References 27 publications

Prognostic factors for colectomy in refractory ulcerative colitis treated with calcineurin inhibitors

Prognostic factors for colectomy in refractory ulcerative colitis treated with calcineurin inhibitors

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

Commentary: predicting response to ciclosporin in acute severe ulcerative colitis

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