Comparison of outcomes of cyclosporine A and infliximab for steroid-refractory acute severe ulcerative colitis

Eun Mi Song, Eun Hye Oh, Sung Wook Hwang, Sang Hyoung Park, Dong Hoon Yang, Jeong Sik Byeon, Seung Jae Myung, Suk Kyun Yang, Byong Duk Ye

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Aim: Data comparing the outcomes of cyclosporin A (CsA) and infliximab (IFX) as rescue therapy for steroid-refractory acute severe ulcerative colitis (SR-ASUC) among Asians are scarce. Methods: In this single-center study, we retrospectively reviewed 121 patients with SR-ASUC according to the Truelove and Witts' criteria who received CsA or IFX as rescue therapy between 1995 and 2015. The cumulative rates of treatment failure and colectomy at 3 months were compared. Treatment failure was defined as colectomy, switch to other medications, acute flare-up events requiring steroid treatment, or adverse events leading to drug interruption. Results: Among 121 patients with SR-ASUC (male, 55.6%; median disease duration, 47.1 months; extensive colitis, 61.2%), 23 received CsA as rescue therapy. Baseline characteristics (e.g. age at diagnosis, sex, disease duration, disease extent at rescue therapy, and Mayo score at treatment initiation) were comparable between the two groups. During follow-up (median, 45 months; interquartile range 29.3–61.8), 84 patients (69.4%) experienced treatment failure, and 25 patients (20.7%) underwent colectomy. The CsA group and the IFX group did not show significant differences in the cumulative rates of treatment failure (39.1% vs 34.7%, P = 0.714) and colectomy (26.1% vs 13.3%, P = 0.198) at 3 months. Previous use of azathioprine (odds ratio [OR] = 2.309, 95% confidence interval [CI] = 1.076–4.951, P = 0.032) was associated with treatment failure at 3 months. Mayo score > 10 at the time of rescue therapy was significantly associated with colectomy at 3 months (OR = 8.444, 95% CI = 2.592–27.506, P < 0.001). Conclusion: Among Korean patients with SR-ASUC, the rates of treatment failure and colectomy at 3 months were not significantly different between the CSA and the IFX treatment groups.

Original languageEnglish
Pages (from-to)2463-2470
Number of pages8
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume36
Issue number9
DOIs
StatePublished - Sep 2021

Keywords

  • colectomy
  • cyclosporine
  • infliximab
  • ulcerative colitis

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