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Long-term Comparative Efficacy of Cyclosporine- or Infliximab-based Strategies for the Management of Steroid-refractory Ulcerative Colitis Attacks

Naves, Juan E. MD*,†; Llaó, Jordina MD†,‡; Ruiz-Cerulla, Alexandra MD§; Romero, Cristina MD; Mañosa, Míriam MD, PhD*; Lobatón, Triana MD§; Cabré, Eduard MD, PhD*; Garcia-Planella, Esther MD; Guardiola, Jordi MD§; Domènech, Eugeni MD, PhD*

doi: 10.1097/MIB.0000000000000101
Original Clinical Articles

Background: The short-term efficacy of infliximab (IFX) and cyclosporine A (CsA) in steroid-refractory ulcerative colitis (SRUC) has been recently shown to be similar, but long-term outcomes are still unclear. Moreover, the need for further rescue therapies in patients treated with IFX or CsA for SRUC has not been reported. The aims of our study were to compare short-term and long-term efficacy between 2 different strategies based on initial treatment with CsA or IFX for SRUC attacks.

Patients and Methods: Between January 2005 and December 2011, all patients admitted for SRUC who required medical rescue therapy were identified from the electronic databases of 3 referral centers and grouped according to whether they received CsA or IFX as first-line rescue therapy, and retrospectively reviewed.

Results: Among 50 SRUC attacks, 20 were treated with CsA as first-line rescue therapy and 30 with IFX. The CsA group had a higher proportion of patients with severe UC activity immediately before rescue therapy (P = 0.03) and a shorter median time from intravenous corticosteroids to rescue therapy (P = 0.03). A higher proportion of patients in the CsA group received second-line drug therapy (switch) as compared with the IFX group (P = 0.04). Fifteen patients (30%) were colectomized during the study period, with no between-group differences. Previous thiopurine exposure (P = 0.004; odds ratio = 6.1 [1.7–20.9]) was the only independent predictor of colectomy.

Conclusions: CsA- and IFX-based strategies for SRUC seem similarly effective in preventing colectomy in the short and long term, although second-line drug therapy is more often required with CsA-based strategies.

Article first published online 25 June 2014.

*Hospital Universitari Germans Trias i Pujol and Ciberehd, Badalona, Spain;

Universitat Autònoma de Barcelona, Barcelona, Spain;

Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; and

§Hospital Universitari de Bellvitge and IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.

Reprints: Eugeni Domènech, MD, PhD, IBD Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916 Badalona, Barcelona, Spain (e-mail: eugenidomenech@gmail.com).

J. E. Naves and J. Llaó contributed equally to the design and conduction of this study.

M. Mañosa, E. Cabré, E. Garcia-Planella, J. Guardiola, and E. Domènech served as speakers, received travel, educational, or research grants from MSD and Abbott. E. Domènech received a research grant (Beca d'intensificació 2013) from the Catalonian Society of Gastroenterology (Societat Catalana de Digestologia) that partly supported this study. The other authors have no conflicts of interest to disclose.

Received April 13, 2014

Accepted May 2, 2014

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