Infliximab or Cyclosporine as Rescue Therapy in Hospitalized Patients with Steroid-Refractory Ulcerative Colitis: A Retrospective Observational Study Academic Article uri icon

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abstract

  • BACKGROUND: Cyclosporine (CsA) or infliximab (IFX) are used as rescue therapies in steroid-refractory, severe attacks of ulcerative colitis (UC). There are no data comparing the efficacy of these two alternatives. METHODS: Outcome of rescue therapy was retrospectively studied in two cohorts of patients hospitalized due to steroid-refractory moderate to severe UC: 1) a Swedish-Danish cohort (n = 49) treated with a single infusion of IFX; 2) an Austrian cohort (n = 43) treated with intravenous CsA. After successful rescue therapy, maintenance immunomodulator treatment was given to 27/33 (82%) of IFX patients and to 31/40 (78%) of CsA patients. Endpoints were colectomy-free survival at 3 and 12 months. Kaplan-Meier and Cox regression models were used to evaluate the association between treatment groups and colectomy. RESULTS: At 15 days, colectomy-free survival in the IFX cohort was 36/49 (73%) versus 41/43 (95%) in the CsA cohort (P = 0.005), at 3 months 33/49 (67%) versus 40/43 (93%) (P = 0.002), and at 12 months 28/49 (57%) versus 33/43 (77%) (P = 0.034). After adjusting for potential confounding factors, Cox regression analysis yielded adjusted hazard ratios for risk of colectomy in IFX-treated patients of 11.2 (95% confidence interval [CI] 2.4-53.1, P = 0.002) at 3 months and of 3.0 (95% CI 1.1-8.2, P = 0.030) at 12 months in comparison with CsA-treated patients. There were no opportunistic infections or mortality. CONCLUSIONS: Colectomy frequencies were significantly lower after rescue therapy with CsA than with a single infusion of IFX both at 3 and 12 months' follow-up. The superiority of CsA was seen principally during the first 15 days.

authors

  • Sjöberg, Mats
  • Walch, Andrea
  • Meshkat, Mina
  • Gustavsson, Anders
  • Järnerot, Gunnar
  • Vogelsang, Harald
  • Hertervig, Erik
  • Novacek, Gottfried
  • Friis-Liby, Ingalill
  • Blomquist, Lars
  • Angelberger, Sieglinde
  • Karlen, Per
  • Grännö, Christer
  • Vilien, Mogens
  • Ström, Magnus
  • Verbaan, Hans
  • Hellström, Per M
  • Dejaco, Clemens
  • Magnuson, Anders
  • Halfvarson, Jonas
  • Reinisch, Walter
  • Tysk, Curt

publication date

  • February 2012