Successive treatment with cyclosporine and infliximab in steroid-refractory ulcerative colitis

S. Leblanc, M. Allez, P. Seksik, B. Flourié, H. Peeters, J. L. Dupas, G. Bouguen, L. Peyrin-Biroulet, B. Duclos, A. Bourreille, O. Dewit, Y. Bouhnik, P. Michetti, S. Chaussade, P. Saussure, J. Y. Mary, J. F. Colombel, M. Lémann

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100 Scopus citations

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.

Original languageEnglish
Pages (from-to)771-777
Number of pages7
JournalAmerican Journal of Gastroenterology
Volume106
Issue number4
DOIs
StatePublished - Apr 2011
Externally publishedYes

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