Introduction: About 30–40% of patients with acute severe ulcerative colitis (UC) fail to respond 23 to intensive intravenous (iv) corticosteroid treatment. Iv cyclosporine and infliximab are an ef- 24 fective rescue therapy in steroid-refractory UC patients but up to now it is still unclear which is Q225 the best therapeutic choice in this setting of patients. 26 Methods: We reviewed our series of severe steroid-refractory colitis admitted consecutively in 27 our referral center since 1994 comparing two historical cohort treated with cyclosporine or 28 infliximab. Iv cyclosporine was administered at the dosage of 2 mg/kg and infliximab at the dos- 29 age of 5 mg/kg. The main outcome was the colectomy rate at 3 months, 12 months and at the 30 end of the follow-up. 31 Results: A total of 65 patients were included: 35 in the cyclosporine group and 30 in the inflix- 32 imab one. After 3 months from the acute episode the colectomy rate was: 28.5% (10/35) in the 33 cyclosporine group and 17% (5/30) in the infliximab group (p=0.25). At 12 months the rate of 34 colectomy increased to 48% in the cyclosporine group versus 17% in the infliximab group 35 (p=0.007, OR 4.7; 95% CI: 1.47–15.16). The 1–2–3 year cumulative colectomy rates were 48%, 36 54%, and 57% in the cyclosporine group, and 17%, 23%, and 27% in the infliximab group. At the 37 end of the follow-up the colectomy rate was: 60% in the cyclosporine group and 30% in the inflix- 38 imab group (p=0.04, HR 2.2; 95% CI: 1.11–4.86). High level of C reactive protein (p=0.04, OR 39 2.9; 95% CI: 1.18–8.28), extensive disease (p=0.01, OR 5.5; 95% CI: 1.57–19.01) and no azathi- 40 oprine treatment after the rescue therapy (pb0.001, OR 8.7; 95% CI: 2.49–30.12) were related 41 to the risk of colectomy.

mocciaro, f., renna, s., orlando, a., rizzuto, g., orlando, e., sinagra, e., et al. (2012). Cyclosporine or infliximab as rescue therapy in severe 2 refractory ulcerative colitis: Early and long-term data 3 from a retrospective observational study. JOURNAL OF CROHN'S AND COLITIS, 6(6), 681-686 [doi:10.1016/j.crohns.2011.11.021].

Cyclosporine or infliximab as rescue therapy in severe 2 refractory ulcerative colitis: Early and long-term data 3 from a retrospective observational study

COTTONE, Mario
2012

Abstract

Introduction: About 30–40% of patients with acute severe ulcerative colitis (UC) fail to respond 23 to intensive intravenous (iv) corticosteroid treatment. Iv cyclosporine and infliximab are an ef- 24 fective rescue therapy in steroid-refractory UC patients but up to now it is still unclear which is Q225 the best therapeutic choice in this setting of patients. 26 Methods: We reviewed our series of severe steroid-refractory colitis admitted consecutively in 27 our referral center since 1994 comparing two historical cohort treated with cyclosporine or 28 infliximab. Iv cyclosporine was administered at the dosage of 2 mg/kg and infliximab at the dos- 29 age of 5 mg/kg. The main outcome was the colectomy rate at 3 months, 12 months and at the 30 end of the follow-up. 31 Results: A total of 65 patients were included: 35 in the cyclosporine group and 30 in the inflix- 32 imab one. After 3 months from the acute episode the colectomy rate was: 28.5% (10/35) in the 33 cyclosporine group and 17% (5/30) in the infliximab group (p=0.25). At 12 months the rate of 34 colectomy increased to 48% in the cyclosporine group versus 17% in the infliximab group 35 (p=0.007, OR 4.7; 95% CI: 1.47–15.16). The 1–2–3 year cumulative colectomy rates were 48%, 36 54%, and 57% in the cyclosporine group, and 17%, 23%, and 27% in the infliximab group. At the 37 end of the follow-up the colectomy rate was: 60% in the cyclosporine group and 30% in the inflix- 38 imab group (p=0.04, HR 2.2; 95% CI: 1.11–4.86). High level of C reactive protein (p=0.04, OR 39 2.9; 95% CI: 1.18–8.28), extensive disease (p=0.01, OR 5.5; 95% CI: 1.57–19.01) and no azathi- 40 oprine treatment after the rescue therapy (pb0.001, OR 8.7; 95% CI: 2.49–30.12) were related 41 to the risk of colectomy.
mocciaro, f., renna, s., orlando, a., rizzuto, g., orlando, e., sinagra, e., et al. (2012). Cyclosporine or infliximab as rescue therapy in severe 2 refractory ulcerative colitis: Early and long-term data 3 from a retrospective observational study. JOURNAL OF CROHN'S AND COLITIS, 6(6), 681-686 [doi:10.1016/j.crohns.2011.11.021].
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10447/63634
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