High-Dose Infliximab Rescue Therapy for Hospitalized Acute Severe Ulcerative Colitis

2019 ◽  
Vol 64 (5) ◽  
pp. 1386-1387
Author(s):  
Cong Dai ◽  
Min Jiang ◽  
Ming-jun Sun
2018 ◽  
Vol 64 (2) ◽  
pp. 518-523 ◽  
Author(s):  
Che-Yung Chao ◽  
Alex Al Khoury ◽  
Achuthan Aruljothy ◽  
Sophie Restellini ◽  
Jonathan Wyse ◽  
...  

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S373-S374
Author(s):  
A Barnes ◽  
P Spizzo

Abstract Background Steroid exposure has been associated with poorer outcomes following colectomy in acute severe ulcerative colitis. Current treatment algorithms suggest three days of high dose intravenous steroid before the decision to commence rescue therapy. We aimed to look at medium-term outcomes in acute severe ulcerative colitis and their predictors including steroid exposure prior to admission. Methods A retrospective case note and electronic record review were conducted at a tertiary inflammatory bowel disease referral centre of admissions for acute severe ulcerative colitis meeting Truelove and Witts criteria from 2013 to 2019. Identified admissions were categorised as: not on steroid prior to admission or on steroid for less than one week prior to admission, on steroid for over one week prior to admission, and on steroid for over one month prior to admission. Data were analysed using Chi-squared test and Fisher’s exact test as appropriate. Results In total, 109 admissions were identified for acute severe ulcerative colitis meeting Truelove and Witts criteria over 2013 to 2019. Rescue therapy was significantly more likely in patients with over one week of steroid exposure prior to admission (76.0% vs. 28.5%, p = 0.0001). Prior steroid exposure was not associated with failure of medical rescue therapy (p = 0.42). Patients with steroid exposure for at least one week prior to admission trended towards increased likelihood to undergo colectomy during admission (32.0% vs. 16.6%, p = 0.0.09) and were significantly more likely to undergo colectomy within one year of admission (44.0% vs. 21.4%, p = 0.028). Excluding patients with a first presentation of inflammatory bowel disease showed that patients with steroid exposure for at least one week prior to admission trended towards significance to undergo colectomy during admission (32.0% vs. 13.2%, p = 0.05) and were significantly more likely to undergo colectomy within one year of admission (44.0% vs. 20.7%, p = 0.036). Readmissions within one year of acute severe ulcerative colitis admission were not significantly different (40.0% vs. 29.7%, p = 0.33). Conclusion Prolonged steroid exposure prior to admission was associated with an increased likelihood of rescue therapy but was not predictive of response to medical rescue therapy. Colectomy rates at one year were significantly higher with over one week of steroid exposure prior to admission. Consideration should be given to early commencement of rescue therapy in those with prolonged steroid exposure prior to admission.


2020 ◽  
Vol 14 (7) ◽  
pp. 1026-1028 ◽  
Author(s):  
Prashant Kotwani ◽  
Jonathan Terdiman ◽  
Sara Lewin

Abstract Background Acute severe ulcerative colitis is a high stakes event with significant numbers still requiring emergent colectomy, representing a need to establish alternative medical management options. We report a case series of tofacitinib as rescue therapy in biologic-experienced patients with acute severe ulcerative colitis. Methods Four patients were identified over a 1-year period at our institution who initiated tofacitinib for acute severe ulcerative colitis. All four had previously failed at least two biologics, including infliximab, and were failing high-dose oral prednisone therapy before admission. All patients had Mayo disease activity index of at least 10 at admission. After no significant improvement despite receiving a minimum of 3 days of intravenous methylprednisolone and based on elevated Ho and Travis indices at Day 3, patients were offered rescue tofacitinib for induction of remission, or colectomy. Standard induction of tofacitinib was used [10 mg twice daily], and one patient was escalated to 15 mg twice daily after inadequate response. Results All patients experienced improvement in objective symptoms and laboratory markers, and were discharged without colectomy on tofacitinib as maintenance therapy and prednisone taper; 30-day and 90-day colectomy rates on tofacitinib maintenance therapy were zero and 90-day readmission rate was also zero. Two of four patients achieved steroid-free remission on maintenance tofacitinib monotherapy based on clinical symptoms and follow-up endoscopy. No major adverse reaction was reported during induction or maintenance therapy. Conclusions Tofacitinib may be an acceptable rescue agent in biologic-experienced patients with acute severe ulcerative colitis. Tofacitinib may also be safely continued as maintenance therapy once remission has been achieved.


Author(s):  
Konstantina Rosiou ◽  
Christian Philipp Selinger

AbstractAcute severe ulcerative colitis is a medical emergency that warrants in-patient management. This is best served within a multidisciplinary team setting in specialised centres or with expert consultation. Intravenous corticosteroids remain the cornerstone in the management of ASUC and should be initiated promptly, along with general management measures and close monitoring of patients. Unfortunately, one-third of patients will fail to respond to steroids. Response to intravenous corticosteroid therapy needs to be assessed on the third day and rescue therapies, including cyclosporine and infliximab, should be offered to patients not responding. Choice of rescue therapy depends on experience, drug availability and factors associated with each individual patient, such as comorbidities, previous medications or contra-indications to therapy. Patients who have not responded within 7 days to rescue therapy must be considered for surgery. Surgery is a treatment option in ASUC and should not be delayed in cases of failure of medical therapy, because such delays increase surgical morbidity and mortality. This review summarises the current management of acute severe ulcerative colitis and discusses potential future developments.


Author(s):  
Sara Santos ◽  
Verónica Gamelas ◽  
Rita Saraiva ◽  
Guilherme Simões ◽  
Joana Saiote ◽  
...  

Tofacitinib has emerged as a new option for ulcerative colitis. Its rapid absorption, metabolism, and clinical improvement make it an interesting option for rescue therapy in acute severe ulcerative colitis (ASUC), a situation with limited therapeutic options in patients with a long-term disease course and multiple drug failure. The management of ASUC in this setting becomes challenging, underlying the need for new drugs and data on their efficacy and safety. We describe 2 cases of acute episodes in which tofacitinib was used as a rescue therapy.


2020 ◽  
pp. 205064062097740
Author(s):  
Stefano Festa ◽  
Maria L Scribano ◽  
Daniela Pugliese ◽  
Cristina Bezzio ◽  
Mariabeatrice Principi ◽  
...  

Background The long-term course of ulcerative colitis after a severe attack is poorly understood. Second-line rescue therapy with cyclosporine or infliximab is effective for reducing short-term colectomy but the impact in the long-term is controversial. Objective The purpose of this study was to evaluate the long-term course of acute severe ulcerative colitis patients who avoid early colectomy either because of response to steroids or rescue therapy. Methods This was a multicentre retrospective cohort study of adult patients with acute severe ulcerative colitis admitted to Italian inflammatory bowel disease referral centres from 2005–2017. All patients received intravenous steroids, and those who did not respond received either rescue therapy or colectomy. For patients who avoided early colectomy (within three months from the index attack), we recorded the date of colectomy, last follow-up visit or death. The primary end-point was long-term colectomy rate in patients avoiding early colectomy. Results From the included 372 patients with acute severe ulcerative colitis, 337 (90.6%) avoided early colectomy. From those, 60.5% were responsive to steroids and 39.5% to the rescue therapy. Median follow-up was 44 months (interquartile range, 21–85). Colectomy-free survival probability was 93.5%, 81.5% and 79.4% at one, three and five years, respectively. Colectomy risk was higher among rescue therapy users than in steroid-responders (log-rank test, p = 0.02). At multivariate analysis response to steroids was independently associated with a lower risk of long-term colectomy (adjusted odds ratio = 0.5; 95% confidence interval, 0.2–0.8), while previous exposure to anti-tumour necrosis factor alpha agents was associated with an increased risk (adjusted odds ratio = 3.0; 95% confidence interval, 1.5–5.7). Approximately 50% of patients required additional therapy or new hospitalization within five years due to a recurrent flare. Death occurred in three patients (0.9%). Conclusions Patients with acute severe ulcerative colitis avoiding early colectomy are at risk of long-term colectomy, especially if previously exposed to anti-tumour necrosis factor alpha agents or if rescue therapy during the acute attack was required because of steroid refractoriness.


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