BACKGROUND: Inpatient management of severe ulcerative colitis is complicated by the use of prior immunosuppressant therapies. Our aim was to determine the rate of 1-year colectomy among individuals receiving inpatient calcineurin inhibitor (CNI)-based therapy stratified by prior biologic therapy. METHODS: A retrospective cohort study was performed between January 1, 2013 and April 1, 2018. Only individuals requiring inpatient administration of intravenous cyclosporine or oral tacrolimus were included in the analysis. Individuals were stratified according to prior biologic therapy exposure. The primary outcome of interest was 1-year risk of colectomy. Kaplan-Meier curves were generated for time-to-event data, and regression models were performed to examine the effects of covariates on the clinical endpoint. RESULTS: Sixty-nine (62.3% male) patients were treated with an inpatient CNI-based therapy and were included in the analysis. Fifteen (21.7%) patients were biologic-naïve, 42 (60.9%) patients had prior exposure to 1 class of biologic therapy, and 12 (17.4%) patients had prior exposure to 2 classes of biologic therapy (third-line CNI therapy). Third-line CNI therapy showed a greater risk of 1-year colectomy risk when compared with the risk for patients who were biologic-naïve (hazard ratio, 3.63; 95% confidence interval, 1.17-13.45; P = 0.025). In a multivariate proportional hazards model, third-line CNI therapy remained significantly associated with 1-year colectomy risk (hazard ratio, 7.94; 95% confidence interval, 1.97-39.76; P = 0.003). CONCLUSIONS: The use of CNI-based therapy in individuals exposed to multiple classes of prior biologic therapies leads to a significantly increased risk of 1-year colectomy. Future studies will be required to compare inpatient management strategies with the expanding novel therapies in UC.
BACKGROUND: Inpatient management of severe ulcerative colitis is complicated by the use of prior immunosuppressant therapies. Our aim was to determine the rate of 1-year colectomy among individuals receiving inpatient calcineurin inhibitor (CNI)-based therapy stratified by prior biologic therapy. METHODS: A retrospective cohort study was performed between January 1, 2013 and April 1, 2018. Only individuals requiring inpatient administration of intravenous cyclosporine or oral tacrolimus were included in the analysis. Individuals were stratified according to prior biologic therapy exposure. The primary outcome of interest was 1-year risk of colectomy. Kaplan-Meier curves were generated for time-to-event data, and regression models were performed to examine the effects of covariates on the clinical endpoint. RESULTS: Sixty-nine (62.3% male) patients were treated with an inpatient CNI-based therapy and were included in the analysis. Fifteen (21.7%) patients were biologic-naïve, 42 (60.9%) patients had prior exposure to 1 class of biologic therapy, and 12 (17.4%) patients had prior exposure to 2 classes of biologic therapy (third-line CNI therapy). Third-line CNI therapy showed a greater risk of 1-year colectomy risk when compared with the risk for patients who were biologic-naïve (hazard ratio, 3.63; 95% confidence interval, 1.17-13.45; P = 0.025). In a multivariate proportional hazards model, third-line CNI therapy remained significantly associated with 1-year colectomy risk (hazard ratio, 7.94; 95% confidence interval, 1.97-39.76; P = 0.003). CONCLUSIONS: The use of CNI-based therapy in individuals exposed to multiple classes of prior biologic therapies leads to a significantly increased risk of 1-year colectomy. Future studies will be required to compare inpatient management strategies with the expanding novel therapies in UC.
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: Nadia Pillai; Mark Dusheiko; Michel H Maillard; Gerhard Rogler; Beat Brüngger; Caroline Bähler; Valérie E H Pittet Journal: J Crohns Colitis Date: 2019-05-27 Impact factor: 9.071
Authors: Matthew C Choy; Dean Seah; David M Faleck; Shailja C Shah; Che-Yung Chao; Yoon-Kyo An; Graham Radford-Smith; Talat Bessissow; Marla C Dubinsky; Alexander C Ford; Leonid Churilov; Neville D Yeomans; Peter P De Cruz Journal: Inflamm Bowel Dis Date: 2019-06-18 Impact factor: 5.325
Authors: Meenakshi Bewtra; Vikram Kilambi; Angelyn O Fairchild; Corey A Siegel; James D Lewis; F Reed Johnson Journal: Inflamm Bowel Dis Date: 2014-01 Impact factor: 5.325
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: Jeffrey A Berinstein; Calen A Steiner; Randolph E Regal; John I Allen; Jami A R Kinnucan; Ryan W Stidham; Akbar K Waljee; Shrinivas Bishu; Leslie B Aldrich; Peter D R Higgins Journal: Clin Gastroenterol Hepatol Date: 2018-11-17 Impact factor: 11.382