Marijana Protic1, Frank Seibold2, Alain Schoepfer3, Zoran Radojicic4, Pascal Juillerat5, Daniela Bojic6, Jessica Mwinyi7, Christian Mottet8, Njegica Jojic9, Christoph Beglinger10, Stephan Vavricka11, Gerhard Rogler12, Pascal Frei13. 1. Department of Gastroenterology, Spital Tiefenau, Tiefenaustrasse 112, 3004 Bern, Switzerland; Division of Clinical Pharmacology and Toxicology, University Hospital Zürich, Zürich, Switzerland. Electronic address: marijana.n.protic@gmail.com. 2. Department of Gastroenterology, Spital Tiefenau, Tiefenaustrasse 112, 3004 Bern, Switzerland; Department of Gastroenterology, Inselspital, University Hospital Bern, Switzerland. Electronic address: Frank.Seibold@spitalnetzbern.ch. 3. Department of Gastroenterology and Hepatology, University Hospital Lausanne, Lausanne, Switzerland. Electronic address: alain.schoepfer@chuv.ch. 4. Department of Statistics, Faculty of Organizational Sciences, Belgrade, Serbia. Electronic address: zoran@fon.rs. 5. Department of Gastroenterology, Inselspital, University Hospital Bern, Switzerland. Electronic address: pascal.juillerat@insel.ch. 6. Department of Gastroenterology, University Hospital Zvezdara, Belgrade, Serbia. Electronic address: 8411112@telenormail.rs. 7. Division of Clinical Pharmacology and Toxicology, University Hospital Zürich, Zürich, Switzerland. Electronic address: jessica.mwinyi@usz.ch. 8. Department of Gastroenterology, Hospital Neuchâtel, Neuchâtel, Switzerland. Electronic address: christian.mottet@h-ne.ch. 9. Department of Gastroenterology, University Hospital Zvezdara, Belgrade, Serbia. Electronic address: ibd@eunet.rs. 10. Department of Gastroenterology, University Hospital Basel, Basel, Switzerland. Electronic address: beglinger@tmr.ch. 11. Department of Gastroenterology and Hepatology, Stadtspital Triemli, Zürich, Switzerland. Electronic address: stephan.vavricka@triemli.stzh.ch. 12. Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland. Electronic address: gerhard.rogler@usz.ch. 13. Department of Gastroenterology, See Spital, Horgen, Switzerland. Electronic address: pascal.frei@see-spital.ch.
Abstract
BACKGROUND: Among patients with steroid-refractory ulcerative colitis (UC) in whom a first rescue therapy has failed, a second line salvage treatment can be considered to avoid colectomy. AIM: To evaluate the efficacy and safety of second or third line rescue therapy over a one-year period. METHODS: Response to single or sequential rescue treatments with infliximab (5mg/kg intravenously (iv) at week 0, 2, 6 and then every 8weeks), ciclosporin (iv 2mg/kg/daily and then oral 5mg/kg/daily) or tacrolimus (0.05mg/kg divided in 2 doses) in steroid-refractory moderate to severe UC patients from 7 Swiss and 1 Serbian tertiary IBD centers was retrospectively studied. The primary endpoint was the one year colectomy rate. RESULTS: 60% of patients responded to the first rescue therapy, 10% went to colectomy and 30% non-responders were switched to a 2(nd) line rescue treatment. 66% of patients responded to the 2(nd) line treatment whereas 34% failed, of which 15% went to colectomy and 19% received a 3(rd) line rescue treatment. Among those, 50% patients went to colectomy. Overall colectomy rate of the whole cohort was 18%. Steroid-free remission rate was 39%. The adverse event rates were 33%, 37.5% and 30% for the first, second and third line treatment respectively. CONCLUSION: Our data show that medical intervention even with 2(nd) and 3(rd) rescue treatments decreased colectomy frequency within one year of follow up. A longer follow-up will be necessary to investigate whether sequential therapy will only postpone colectomy and what percentage of patients will remain in long-term remission.
BACKGROUND: Among patients with steroid-refractory ulcerative colitis (UC) in whom a first rescue therapy has failed, a second line salvage treatment can be considered to avoid colectomy. AIM: To evaluate the efficacy and safety of second or third line rescue therapy over a one-year period. METHODS: Response to single or sequential rescue treatments with infliximab (5mg/kg intravenously (iv) at week 0, 2, 6 and then every 8weeks), ciclosporin (iv 2mg/kg/daily and then oral 5mg/kg/daily) or tacrolimus (0.05mg/kg divided in 2 doses) in steroid-refractory moderate to severe UC patients from 7 Swiss and 1 Serbian tertiary IBD centers was retrospectively studied. The primary endpoint was the one year colectomy rate. RESULTS: 60% of patients responded to the first rescue therapy, 10% went to colectomy and 30% non-responders were switched to a 2(nd) line rescue treatment. 66% of patients responded to the 2(nd) line treatment whereas 34% failed, of which 15% went to colectomy and 19% received a 3(rd) line rescue treatment. Among those, 50% patients went to colectomy. Overall colectomy rate of the whole cohort was 18%. Steroid-free remission rate was 39%. The adverse event rates were 33%, 37.5% and 30% for the first, second and third line treatment respectively. CONCLUSION: Our data show that medical intervention even with 2(nd) and 3(rd) rescue treatments decreased colectomy frequency within one year of follow up. A longer follow-up will be necessary to investigate whether sequential therapy will only postpone colectomy and what percentage of patients will remain in long-term remission.
Authors: G Pellino; D S Keller; G M Sampietro; I Angriman; M Carvello; V Celentano; F Colombo; F Di Candido; S Laureti; G Luglio; G Poggioli; M Rottoli; S Scaringi; G Sciaudone; G Sica; L Sofo; S Leone; S Danese; A Spinelli; G Delaini; F Selvaggi Journal: Tech Coloproctol Date: 2020-03-14 Impact factor: 3.781
Authors: Roni Weisshof; Jacob E Ollech; Katia El Jurdi; Olivia V Yvellez; Russell D Cohen; Atsushi Sakuraba; Sushila Dalal; Joel Pekow; David T Rubin Journal: J Crohns Colitis Date: 2019-09-19 Impact factor: 9.071
Authors: Kata Szemes; Alexandra Soós; Péter Hegyi; Nelli Farkas; Adrienn Erős; Bálint Erőss; Emese Mezősi; Zsolt Szakács; Katalin Márta; Patrícia Sarlós Journal: Front Med (Lausanne) Date: 2020-01-21