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Rescue Therapy with Cyclosporine or Infliximab is not Associated with an Increased Risk for Postoperative Complications in Patients Hospitalized for Severe Steroid-refractory Ulcerative Colitis

Nelson, Ryan MD*; Liao, Chuanhong MS; Fichera, Alessandro MD; Rubin, David T. MD*; Pekow, Joel MD*

doi: 10.1097/01.MIB.0000437497.07181.05
Original Clinical Articles

Background: Cyclosporine and infliximab (IFX) are effective medical therapies for inducing remission in patients with steroid-refractory ulcerative colitis (UC). Patients with acute severe disease who do not respond to these therapies require colectomy, however, the risk of postoperative complications in such patients is not known. Analyzing patients with acute severe UC, we compared the incidence of postoperative complications in patients who failed rescue therapy with cyclosporine or IFX with that in patients who received intravenous (IV) corticosteroids alone.

Methods: We performed a retrospective cohort study of UC patients who underwent colectomy after inpatient treatment with cyclosporine plus IV corticosteroids (CsA+IVS), infliximab plus IV corticosteroids (IFX+IVS), or IV corticosteroids alone (IVS) at the University of Chicago Hospitals from October 1, 2006 to October 1, 2012. Primary endpoints were infectious, noninfectious, and total complications occurring within 30 days of colectomy.

Results: Of 78 patients, 19 were treated with CsA+IVS, 24 with IFX+IVS, 4 with both CsA and IFX+IVS, and 31 with IVS alone. Patients treated with rescue therapy plus IVS had no difference in total postoperative complications compared with those receiving IVS alone (CsA+IVS: relative risk (RR) = 0.63, 95% confidence interval (CI), 0.33–1.23; IFX+IVS: RR = 0.65, 95% CI, 0.36–1.17). There remained no difference in postoperative complications between the rescue therapy and IVS alone groups when subcategorizing overall complications into infectious (CsA+IVS: RR = 0.54, 95% CI, 0.17–1.76; IFX+IVS: RR = 0.86, 95% CI, 0.36–2.09) and noninfectious (CsA+IVS: RR = 0.88, 95% CI, 0.43–1.80; IFX+IVS: RR = 0.40, 95% CI, 0.15–1.07) causes.

Conclusions: Cyclosporine and IFX are not associated with an increased risk for postoperative complications in patients hospitalized for severe UC refractory to corticosteroids.

Article first published online 27 November 2013

*Section of Gastroenterology, Hepatology, and Nutrition,

Department of Health Studies, the University of Chicago Medicine, Chicago, Illinois; and

Department of Surgery, University of Washington Medicine, Seattle, Washington.

Reprints: Joel Pekow, MD, Section of Gastroenterology, Hepatology, and Nutrition, the University of Chicago Medicine, 900 East 57th Street, MB#9, Chicago, IL 60637 (e-mail: jpekow@medicine.bsd.uchicago.edu).

David Rubin is a consultant for Janssen and receives grant support (TREAT registry). The other authors have no conflicts of interest to disclose.

Supported in part by grants P30DK42086 (Digestive Diseases Research Core Center) and K08DK090152 (Pekow).

Received October 03, 2013

Accepted October 15, 2013

© Crohn's & Colitis Foundation of America, Inc.
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