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- Title
Successive Treatment With Cyclosporine and Infliximab in Steroid-Refractory Ulcerative Colitis.
- Authors
Leblanc, S.; Allez, M.; Seksik, P.; Flourié, B.; Peeters, H.; Dupas, J. L.; Bouguen, G.; Peyrin-Biroulet, L.; Duclos, B.; Bourreille, A.; Dewit, O.; Bouhnik, Y.; Michetti, P.; Chaussade, S.; Saussure, P.; Mary, J. Y.; Colombel, J. F.; Lémann, M.
- Abstract
OBJECTIVES:Rescue therapy with either cyclosporine (CYS) or infliximab (IFX) is an effective option in patients with intravenous steroid-refractory attacks of ulcerative colitis (UC). In patients who fail, colectomy is usually recommended, but a second-line rescue therapy with IFX or CYS is an alternative. The aims of this study were to investigate the efficacy and tolerance of IFX and CYS as a second-line rescue therapy in steroid-refractory UC or indeterminate colitis (IC) unsuccessfully treated with CYS or IFX.METHODS:This was a retrospective survey of patients seen during the period 2000-2008 in the GETAID centers. Inclusion criteria included a delay of <1 month between CYS withdrawal (when used first) and IFX, or a delay of <2 months between IFX (when used first) and CYS, and a follow-up of at least 3 months after inclusion. Time-to-colectomy, clinical response, and occurrence of serious adverse events were analyzed.RESULTS:A total of 86 patients (median age 34 years; 49 males; 71 UC and 15 IC) were successively treated with CYS and IFX. The median (±s.e.) follow-up time was 22.6 (7.0) months. During the study period, 49 patients failed to respond to the second-line rescue therapy and underwent a colectomy. The probability of colectomy-free survival (±s.e.) was 61.3±5.3% at 3 months and 41.3±5.6 % at 12 months. A case of fatal pulmonary embolism occurred at 1 day after surgery in a 45-year-old man. Also, nine infectious complications were observed during the second-line rescue therapy.CONCLUSIONS:In patients with intravenous steroid-refractory UC and who fail to respond to CYS or IFX, a second-line rescue therapy may be effective in carefully selected patients, avoiding colectomy within 2 months in two-thirds of them. The risk/benefit ratio should still be considered individually.
- Subjects
CYCLOSPORINE; INFLIXIMAB; COLITIS treatment; ULCERATIVE colitis; COLECTOMY; RETROSPECTIVE studies; HEALTH surveys; PULMONARY artery; PULMONARY embolism; PATIENTS; SURGERY; THERAPEUTICS
- Publication
American Journal of Gastroenterology (Springer Nature), 2011, Vol 106, Issue 4, p771
- ISSN
0002-9270
- Publication type
Article
- DOI
10.1038/ajg.2011.62