BACKGROUND AND AIMS: Options for medical management of patients with acute severe colitis [ASC] failing intravenous (i.v.) steroids are limited and include rescue therapy with either infliximab or ciclosporin. In patients failing infliximab, second-line rescue therapy with ciclosporin is an alternative. The aim of this study was to investigate the efficacy and safety of ciclosporin in patients with steroid-refractory ASC failing first-line rescue therapy with infliximab. METHODS: This is a retrospective, tertiary centre study undertaken from 2010 to 2017. Included were patients hospitalized for ASC and treated with i.v. ciclosporin after failing i.v. steroids and infliximab within the previous 2 months. Time to colectomy, clinical response, and occurrence of adverse events were analysed. RESULTS: Forty patients with steroid-resistant ASC were included. Patients were followed for a median of 13 months (interquartile range [IQR] 5-32 months). Colectomy-free survival was 65%, 59.4%, and 41.8% at 1 month, 3 months and 1 year, respectively. Sixty percent of patients [24/40] achieved clinical remission at a median of 2 weeks [IQR 1-3 weeks]. Infliximab levels before ciclosporin infusion were available for 26 patients [median level 17.5 mg/mL, IQR 8-34 mg/mL] and were not associated with adverse events. Sixteen patients [40%] experienced adverse events after ciclosporin treatment, but none resulted in drug discontinuation. CONCLUSIONS: In patients with i.v. steroid-refractory ASC who failed infliximab therapy, second-line rescue therapy with ciclosporin was shown to be effective and safe. This is the largest patient cohort to receive ciclosporin as second-line rescue therapy for ASC. We believe that ciclosporin may be offered to selected patients prior to referral for colectomy.
BACKGROUND AND AIMS: Options for medical management of patients with acute severe colitis [ASC] failing intravenous (i.v.) steroids are limited and include rescue therapy with either infliximab or ciclosporin. In patients failing infliximab, second-line rescue therapy with ciclosporin is an alternative. The aim of this study was to investigate the efficacy and safety of ciclosporin in patients with steroid-refractory ASC failing first-line rescue therapy with infliximab. METHODS: This is a retrospective, tertiary centre study undertaken from 2010 to 2017. Included were patients hospitalized for ASC and treated with i.v. ciclosporin after failing i.v. steroids and infliximab within the previous 2 months. Time to colectomy, clinical response, and occurrence of adverse events were analysed. RESULTS: Forty patients with steroid-resistant ASC were included. Patients were followed for a median of 13 months (interquartile range [IQR] 5-32 months). Colectomy-free survival was 65%, 59.4%, and 41.8% at 1 month, 3 months and 1 year, respectively. Sixty percent of patients [24/40] achieved clinical remission at a median of 2 weeks [IQR 1-3 weeks]. Infliximab levels before ciclosporin infusion were available for 26 patients [median level 17.5 mg/mL, IQR 8-34 mg/mL] and were not associated with adverse events. Sixteen patients [40%] experienced adverse events after ciclosporin treatment, but none resulted in drug discontinuation. CONCLUSIONS: In patients with i.v. steroid-refractory ASC who failed infliximab therapy, second-line rescue therapy with ciclosporin was shown to be effective and safe. This is the largest patient cohort to receive ciclosporin as second-line rescue therapy for ASC. We believe that ciclosporin may be offered to selected patients prior to referral for colectomy.
Authors: Gunnar Järnerot; Erik Hertervig; Ingalill Friis-Liby; Lars Blomquist; Per Karlén; Christer Grännö; Mogens Vilien; Magnus Ström; Ake Danielsson; Hans Verbaan; Per M Hellström; Anders Magnuson; Bengt Curman Journal: Gastroenterology Date: 2005-06 Impact factor: 22.682
Authors: Britt Christensen; Peter R Gibson; Dejan Micic; Ruben J Colman; Sarah R Goeppinger; Olufemi Kassim; Andres Yarur; Christopher R Weber; Russell D Cohen; David T Rubin Journal: Clin Gastroenterol Hepatol Date: 2018-05-08 Impact factor: 11.382
Authors: Johannan F Brandse; Gijs R van den Brink; Manon E Wildenberg; Desiree van der Kleij; Theo Rispens; Jeroen M Jansen; Ron A Mathôt; Cyriel Y Ponsioen; Mark Löwenberg; Geert R A M D'Haens Journal: Gastroenterology Date: 2015-04-25 Impact factor: 22.682
Authors: Gary R Lichtenstein; Edward V Loftus; Kim L Isaacs; Miguel D Regueiro; Lauren B Gerson; Bruce E Sands Journal: Am J Gastroenterol Date: 2018-03-27 Impact factor: 10.864
Authors: I Ordás; E Domènech; M Mañosa; V García-Sánchez; E Iglesias-Flores; M Peñalva; A Cañas-Ventura; O Merino; F Fernández-Bañares; F Gomollón; M Vera; A Gutiérrez; E Garcia-Planella; M Chaparro; M Aguas; E Gento; F Muñoz; M Aguirresarobe; C Muñoz; L Fernández; X Calvet; C E Jiménez; M A Montoro; A Mir; M L De Castro; M F García-Sepulcre; F Bermejo; J Panés; M Esteve Journal: Am J Gastroenterol Date: 2017-07-04 Impact factor: 10.864
Authors: John G Williams; M Fasih Alam; Laith Alrubaiy; Ian Arnott; Clare Clement; David Cohen; John N Gordon; A Barney Hawthorne; Mike Hilton; Hayley A Hutchings; Aida U Jawhari; Mirella Longo; John Mansfield; Jayne M Morgan; Frances Rapport; Anne C Seagrove; Shaji Sebastian; Ian Shaw; Simon P L Travis; Alan Watkins Journal: Lancet Gastroenterol Hepatol Date: 2016-09