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Severe ulcerative colitis: predictors of response and algorithm proposal for rescue therapy.

Abstract：

BACKGROUND:There is no agreeing if rescue therapy can avoid short-term colectomy in patients treated for severe steroid-refractory ulcerative colitis. AIMS:The aim of our study was to identify predictors of response to infliximab and cyclosporine A. METHODS:In this cross-sectional study, 49 patients with severe ulcerative colitis were included. Response to therapy was defined as three or more point reductions in Mayo score after 6 months of treatment and avoidance of colectomy after 1 year. The predictors analysed were gender, age, time from ulcerative colitis diagnosis, months of steroid or/and azathioprine therapy before onset of the severe phase, smoking habits, extension of the disease, laboratory analyses and Mayo score. RESULTS:Patients treated with infliximab showed a statistically significant higher response rate in case of moderate Mayo score (P = 0.04). Ex-smokers had very low chance of response to infliximab (P = 0.03). In the group treated with cyclosporine A, patients with C-reactive protein >3 mg/L had a response rate significantly higher than those with C-reactive protein <3 mg/L (P = 0.03); those with negative C-reactive protein and moderate Mayo score did not responded to therapy, while in the ones with elevated C-reactive protein and/or severe Mayo score, 15 versus 4 responded (P = 0.008). CONCLUSIONS:Our data suggest that cyclosporine A is advisable in ex-smokers. In never smokers or active smokers, infliximab can be prescribed in case of Mayo score ≤10 and/or negative CRP, while cyclosporine A is indicated in case of Mayo score >10 and positive CRP.

journal_name

Ir J Med Sci

journal_title

Irish journal of medical science

authors

Ribaldone DG,Dileo I,Pellicano R,Resegotti A,Fagoonee S,Vernero M,Saracco G,Astegiano M

doi

10.1007/s11845-017-1666-0

subject

Has Abstract

pub_date

2018-05-01 00:00:00

pages

385-392

issue

2

eissn

0021-1265

issn

1863-4362

pii

10.1007/s11845-017-1666-0

journal_volume

187

pub_type

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