Improved outcome of acute severe ulcerative colitis while using early predictors of corticosteroid failure and rescue therapies.
BACKGROUND AND AIM
Intravenous corticosteroids remain the first line therapy for severe attacks of ulcerative colitis although up to 30-40% of patients do not respond to treatment. The availability of alternative therapies to colectomy and the knowledge of early predictors of response to corticosteroids should have improved the clinical outcomes of patients with severe refractory ulcerative colitis. The aim of the study is to describe the current need, way of use, and efficacy of rescue therapies, as well as colectomy rates in patients with severe ulcerative colitis flares.


METHODS
Between January 2005 and December 2011, all patients admitted in three referral centres for a severe ulcerative colitis flare who received intravenous corticosteroids were identified and clinical and biological data were accurately collected. Patients were followed-up until colectomy, death, or date of data collection.


RESULTS
Sixty-two flares were included. Initial efficacy of intravenous corticosteroids (mild activity or inactive disease without rescue treatment, at day 7 after starting intravenous corticosteroids) was achieved in 50% of flares, and rescue therapies were used in 27 episodes (43%). After a median follow-up of 18 months, the colectomy rate was 6.5%. Failed oral corticosteroids for the index flare were the only baseline feature that predicted the need for rescue therapy and colectomy.


CONCLUSIONS
There is a marked reduction in the colectomy rate and an increased use of medical rescue therapies as compared to historical series. Patients worsening while on oral corticosteroids for a moderate flare are at high risk of rescue therapy and colectomy and, therefore, should be directly treated with rescue therapies instead of attempting intravenous corticosteroids.
['Llaó|Jordina|J|', 'Naves|Juan E|JE|', 'Ruiz-Cerulla|Alexandra|A|', 'Gordillo|Jordi|J|', 'Mañosa|Míriam|M|', 'Maisterra|Sandra|S|', 'Cabré|Eduard|E|', 'Garcia-Planella|Esther|E|', 'Guardiola|Jordi|J|', 'Domènech|Eugeni|E|']
D061605:Administration, Intravenous D000305:Adrenal Cortex Hormones D000328:Adult D003082:Colectomy D003093:Colitis, Ulcerative D016572:Cyclosporine D005260:Female D005500:Follow-Up Studies D005765:Gastrointestinal Agents D006801:Humans D007166:Immunosuppressive Agents D000069285:Infliximab D053208:Kaplan-Meier Estimate D016015:Logistic Models D008297:Male D008875:Middle Aged D012189:Retrospective Studies D012720:Severity of Illness Index D013030:Spain D062606:Tertiary Care Centers D017211:Treatment Failure
Ulcerative colitis Corticosteroids Colectomy Cyclosporine Infliximab