How effective is current medical therapy for severe ulcerative and Crohn's colitis? An analytic review of selected trials.

To determine the efficacy of current medical therapies in the treatment of severe ulcerative and Crohn's colitis, we conducted a MEDLINE computer-assisted literature search using the terms "severe ulcerative colitis," "severe Crohn's colitis," "drugs," and "therapy." Studies were compared and then selected based, in decreasing order of importance, on the use of standard criteria to assess disease severity, uniform entrance criteria with prospective drug protocols using defined end points; prospective placebo-controlled trials; and retrospective studies. We then conducted an analytic review of those studies selected. For severe ulcerative colitis, we identified seven studies comprising 319 treatment episodes in 306 patients. Clinical remission was achieved on average in 62% of subjects (range, 43-80%); 38% (25-57%) came to prompt colectomy. Remission was maintained in 38-71% of patients achieving success in the acute phase. For severe Crohn's colitis, we identified five studies comprising 68 patients. Clinical remission was achieved on average in 65% of patients (range, 55-94%). Remission was maintained in 54-69% of those achieving success in the acute phase. Current medical therapies have improved the outlook for severe ulcerative colitis; however, physicians cannot predict response to therapy based upon individual's clinical features or previous presentations. Current medical therapy for severe Crohn's colitis appears to spare many patients early colectomy, but the current dearth of clinical trials postpones any further advances in the medical management of these patients.