Journal Article

Successive Treatment With Cyclosporine and Infliximab in Steroid-Refractory Ulcerative Colitis

Flourié, B, Allez, M, Peeters, H, Michetti, P, Bourreille, A, Colombel, J F, Dewit, O, Saussure, P, Duclos, B, Leblanc, S, Peyrin-Biroulet, L, Bouhnik, Y, Dupas, J L, Seksik, P, Mary, J Y, Lémann, M, Bouguen, G, Chaussade, S

2011

Overview

Rescue therapy with either cyclosporine (CYS) or infliximab (IFX) is an effective option in patients with intravenous steroid-refractory attacks of ulcerative colitis (UC). In patients who fail, colectomy is usually recommended, but a second-line rescue therapy with IFX or CYS is an alternative. The aims of this study were to investigate the efficacy and tolerance of IFX and CYS as a second-line rescue therapy in steroid-refractory UC or indeterminate colitis (IC) unsuccessfully treated with CYS or IFX. This was a retrospective survey of patients seen during the period 2000-2008 in the GETAID centers. Inclusion criteria included a delay of <1 month between CYS withdrawal (when used first) and IFX, or a delay of <2 months between IFX (when used first) and CYS, and a follow-up of at least 3 months after inclusion. Time-to-colectomy, clinical response, and occurrence of serious adverse events were analyzed. A total of 86 patients (median age 34 years; 49 males; 71 UC and 15 IC) were successively treated with CYS and IFX. The median (± s.e.) follow-up time was 22.6 (7.0) months. During the study period, 49 patients failed to respond to the second-line rescue therapy and underwent a colectomy. The probability of colectomy-free survival (± s.e.) was 61.3 ± 5.3% at 3 months and 41.3 ± 5.6 % at 12 months. A case of fatal pulmonary embolism occurred at 1 day after surgery in a 45-year-old man. Also, nine infectious complications were observed during the second-line rescue therapy. In patients with intravenous steroid-refractory UC and who fail to respond to CYS or IFX, a second-line rescue therapy may be effective in carefully selected patients, avoiding colectomy within 2 months in two-thirds of them. The risk/benefit ratio should still be considered individually.

• Publisher: Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins,Lippincott, Williams & Wilkins
• Subject: Administration, Oral / Adolescent / Adult / Anti-Inflammatory Agents - administration & dosage / Anti-Inflammatory Agents - adverse effects / Antibodies, Monoclonal - administration & dosage / Antibodies, Monoclonal - adverse effects / Chemical Sciences / Child / Colectomy / Colitis, Ulcerative - drug therapy / Colitis, Ulcerative - surgery / Cyclosporine - administration & dosage / Cyclosporine - adverse effects / Drug Resistance / Female / Follow-Up Studies / Gastroenterology / Humans / Infection - chemically induced / Infliximab / Injections, Intravenous / Male / Middle Aged / Organic chemistry / Pulmonary Embolism - chemically induced / Pulmonary Embolism - mortality / Retrospective Studies / Salvage Therapy - methods / Steroids - administration & dosage / Treatment Outcome / Young Adult