scholarly journals MANAGEMENT OF ACUTE SEVERE ULCERATIVE COLITIS: A CLINICAL UPDATE

2016 ◽  
Vol 29 (3) ◽  
pp. 201-205 ◽  
Author(s):  
Carlos Walter SOBRADO ◽  
Lucas Faraco SOBRADO
Keyword(s):  
Maintenance Therapy ◽  
Rescue Therapy ◽  
Medical Emergency ◽  
Cochrane Library ◽  
Additional Information ◽  
Emergency Colectomy ◽  
Increased Risk ◽  
Profuse Hemorrhage ◽  
Acute Severe Colitis ◽  
Severe Colitis

ABSTRACT Introduction: Acute severe colitis is a potentially lethal medical emergency and, even today, its treatment remains a challenge for clinicians and surgeons. Intravenous corticoid therapy, which was introduced into the therapeutic arsenal in the 1950s, continues to be the first-line treatment and, for patients who are refractory to this, the rescue therapy may consist of clinical measures or emergency colectomy. Objective: To evaluate the indications for and results from drug rescue therapy (cyclosporine, infliximab and tacrolimus), and to suggest a practical guide for clinical approaches. Methods: The literature was reviewed using the Medline/PubMed, Cochrane library and SciELO databases, and additional information from institutional websites of interest, by cross-correlating the following keywords: acute severe colitis, fulminating colitis and treatment. Results: Treatments for acute severe colitis have avoided colectomy in 60-70% of the cases, provided that they have been started early on, with multidisciplinary follow-up. Despite the adverse effects of intravenous cyclosporine, this drug has been indicated in cases of greater severity with an imminent risk of colectomy, because of its fast action, short half-life and absence of increased risk of surgical complications. Therapy using infliximab has been reserved for less severe cases and those in which immunosuppressants are being or have been used (AZA/6-MP). Indication of biological agents has recently been favored because of their ease of therapeutic use, their good short and medium-term results, the possibility of maintenance therapy and also their action as a "bridge" for immunosuppressant action (AZA/6-MP). Colectomy has been reserved for cases in which there is still no response five to seven days after rescue therapy and in cases of complications (toxic megacolon, profuse hemorrhage and perforation). Conclusion: Patients with a good response to rescue therapy who do not undergo emergency operations should be considered for maintenance therapy using azathioprine. A surgical procedure is indicated for selected cases.

scholarly journals How to manage: acute severe colitis

2021 ◽  
pp. flgastro-2020-101710
Author(s):  
Thomas Edward Conley ◽  
Joseph Fiske ◽  
Sreedhar Subramanian
Keyword(s):  
Medical Therapy ◽  
Medical Emergency ◽  
Timely Manner ◽  
Joint Management ◽  
Operative Outcomes ◽  
Emergency Colectomy ◽  
Colorectal Surgeons ◽  
Management Approaches ◽  
Acute Severe Colitis ◽  
Severe Colitis

Acute severe ulcerative colitis (ASUC) is a medical emergency which is associated with significant morbidity and a mortality rate of 1%. ASUC requires prompt recognition and treatment. Optimal management includes admission to a specialist gastrointestinal unit and joint management with colorectal surgeons. Patients need to be screened for concomitant infections and thromboprophylaxis should be administered to mitigate against the elevated risk of thromboembolism. Corticosteroids are still the preferred initial medical therapy but approximately 30%–40% of patients fail steroid therapy and require rescue medical therapy with either infliximab or cyclosporine. Emergency colectomy is required in a timely manner for patients who fail rescue medical therapy to minimise the risk of adverse post-operative outcomes. We discuss current and emerging evidence in the management of ASUC and outline management approaches for clinicians involved in managing ASUC.

scholarly journals Infliximab in acute severe colitis: getting the right dose

2020 ◽  
Vol 11 (6) ◽  
pp. 427-429
Author(s):  
Joseph Fiske ◽  
Thomas Conley ◽  
Shaji Sebastian ◽  
Sreedhar Subramanian
Keyword(s):  
Rescue Therapy ◽  
Medical Emergency ◽  
Published Data ◽  
Prompt Treatment ◽  
Acute Severe Colitis ◽  
Intravenous Steroids ◽  
The Right ◽  
Severe Colitis

Acute severe colitis is a medical emergency and requires prompt treatment with intravenous steroids. Infliximab is typically used as rescue therapy in those who fail to respond to corticosteroids. This article outlines the altered pharmacokinetics of infliximab in acute severe UC and summarised the latest published data surrounding accelerated infliximab dosing.

scholarly journals Ciclosporin Therapy After Infliximab Failure in Hospitalized Patients With Acute Severe Colitis is Effective and Safe

2019 ◽  
Vol 13 (9) ◽  
pp. 1105-1110 ◽  
Author(s):  
Roni Weisshof ◽  
Jacob E Ollech ◽  
Katia El Jurdi ◽  
Olivia V Yvellez ◽  
Russell D Cohen ◽  
...  
Keyword(s):  
Adverse Events ◽  
Rescue Therapy ◽  
Drug Discontinuation ◽  
Second Line ◽  
Steroid Resistant ◽  
Tertiary Centre ◽  
Acute Severe Colitis ◽  
To Receive ◽  
Severe Colitis ◽  
Steroid Refractory

Abstract Background and Aims Options for medical management of patients with acute severe colitis [ASC] failing intravenous (i.v.) steroids are limited and include rescue therapy with either infliximab or ciclosporin. In patients failing infliximab, second-line rescue therapy with ciclosporin is an alternative. The aim of this study was to investigate the efficacy and safety of ciclosporin in patients with steroid-refractory ASC failing first-line rescue therapy with infliximab. Methods This is a retrospective, tertiary centre study undertaken from 2010 to 2017. Included were patients hospitalized for ASC and treated with i.v. ciclosporin after failing i.v. steroids and infliximab within the previous 2 months. Time to colectomy, clinical response, and occurrence of adverse events were analysed. Results Forty patients with steroid-resistant ASC were included. Patients were followed for a median of 13 months (interquartile range [IQR] 5–32 months). Colectomy-free survival was 65%, 59.4%, and 41.8% at 1 month, 3 months and 1 year, respectively. Sixty percent of patients [24/40] achieved clinical remission at a median of 2 weeks [IQR 1–3 weeks]. Infliximab levels before ciclosporin infusion were available for 26 patients [median level 17.5 mg/mL, IQR 8–34 mg/mL] and were not associated with adverse events. Sixteen patients [40%] experienced adverse events after ciclosporin treatment, but none resulted in drug discontinuation. Conclusions In patients with i.v. steroid–refractory ASC who failed infliximab therapy, second-line rescue therapy with ciclosporin was shown to be effective and safe. This is the largest patient cohort to receive ciclosporin as second-line rescue therapy for ASC. We believe that ciclosporin may be offered to selected patients prior to referral for colectomy.

scholarly journals Management of Acute Severe Colitis in the Era of Biologicals and Small Molecules

2019 ◽  
Vol 8 (12) ◽  
pp. 2169
Author(s):  
Christine Verdon ◽  
Talat Bessissow ◽  
Peter L. Lakatos
Keyword(s):  
Ulcerative Colitis ◽  
Small Molecules ◽  
Patient Monitoring ◽  
Treatment Options ◽  
Medical Emergency ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
New Treatment ◽  
Acute Severe Colitis ◽  
Severe Colitis

Acute severe ulcerative colitis (ASUC) is a medical emergency which occurs in about 20%–30% of patients with ulcerative colitis during their lifetime, and does carry a mortality risk of 1%. The management of inflammatory bowel diseases has evolved with changes in objective patient monitoring, as well as the availability of new treatment options with the development of new biological and small molecules; however, data is limited regarding their use in the context of ASUC. This review aims to discuss the emerging data regarding biologicals and small molecules therapies in the context of ASUC.

Mo1891 - Hypoalbuminemia and Bandemia Predict Failure of Infliximab Rescue Therapy in Acute Severe Colitis Independent of the Infliximab Dose

2018 ◽  
Vol 154 (6) ◽  
pp. S-841 ◽  
Author(s):  
Gaurav Syal ◽  
Lori Robbins ◽  
Amir Kashani ◽  
Nirupama Bonthala ◽  
Eric Vasiliauskas ◽  
...  
Keyword(s):  
Rescue Therapy ◽  
Acute Severe Colitis ◽  
Severe Colitis

scholarly journals P209 Prospective validation of faecal calprotectin as a predictor of steroid failure in patients with acute severe colitis

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S244-S244
Author(s):  
P SAHU ◽  
S Kumar ◽  
S Jain ◽  
N Singh Mohil ◽  
P Sahni ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Rescue Therapy ◽  
Univariate Analysis ◽  
Primary Outcome Measure ◽  
Roc Curve Analysis ◽  
Faecal Calprotectin ◽  
Infectious Colitis ◽  
Good Diagnostic Accuracy ◽  
Acute Severe Colitis ◽  
Severe Colitis

Abstract Background Optimal outcomes in acute severe colitis (ASC) are related to time-bound management based upon an early prediction of response to intravenous (IV) corticosteroids. We have demonstrated good diagnostic accuracy of day 3 faecal calprotectin (FCP) in this setting. The present study intended to validate these findings in a different cohort. Methods This prospective cohort study included IV steroid naïve (for this episode) patients with ASC, satisfying Truelove and Witts’ criteria, hospitalised from September 2018 to August 2019. Patients were subjected to baseline sigmoidoscopy, day 1 and day 3 faecal calprotectin, baseline hemogram and biochemistry, and day 3 CRP. All patients received IV steroids after hospitalisation, and the primary outcome measure was steroid-failure defined as colectomy and/or rescue therapy with ciclosporin or infliximab during admission. Results Of 47 patients with ASC, eight were excluded (four received steroids outside, 2-directly taken for surgery/infliximab therapy, 1-toxic megacolon on day 1, 1-infectious colitis), 39 were finally included [mean age−36.08 ± 12.58 years, male (30.7%)]. Fifteen patients (38.5%) failed IV steroids and required rescue therapy (10 infliximab, 2 cyclosporine, four surgery). On univariate analysis, the factors significantly different between steroid responders and steroid failure included UCEIS >6 at baseline, Day 1 and Day 3 FCP, day 5 stool frequency, day 5 ESR and CRP, and oxford criteria (Figure 1). On multivariate analysis, only D3 FCP, UCEIS at baseline and Oxford criteria were significant predictors of steroid failure. Like the previous study, on ROC curve analysis, the day 3 FCP had similar diagnostic accuracy [AUC-0.86(0.75–0.98), and 1120.61 μg/g as a cut-off could predict steroid failure with 87% sensitivity and 79% specificity. Similarly, a combination of baseline UCEIS>6 and day 3 FCP>1120.61 μg/g had 100% specificity and positive predictive value for steroid failure. Conclusion FCP retained its value as an objective predictor of steroid failure in ASC.

scholarly journals Efficacy and safety of bortezomib maintenance in patients with newly diagnosed multiple myeloma: a meta-analysis

2017 ◽  
Vol 37 (4) ◽  
Author(s):  
Chun-yan Sun ◽  
Jun-ying Li ◽  
Zhang-bo Chu ◽  
Lu Zhang ◽  
Lei Chen ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Maintenance Therapy ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Cochrane Library ◽  
Newly Diagnosed ◽  
Efficacy And Safety ◽  
Increased Risk ◽  
The Cochrane Library

Multiple myeloma (MM) is a B-cell neoplasm with a high incidence of relapse. Bortezomib has been extensively studied for the maintenance treatment of MM. Here, we carried out a meta-analysis to determine the efficacy and safety of maintenance therapy with bortezomib. We searched for clinical trials in PubMed (Medline), Embase (OVID), and the Cochrane Library. Two randomized controlled trials (RCTs) enrolling a total of 1338 patients were included. Bortezomib maintenance statistically significantly improved both progression-free survival (PFS) (hazard ratio (HR) 0.67, 95% confidence interval (CI) = 0.51 to 0.87, P=0.003) and overall survival (OS) (HR = 0.75 therapy, 95% CI = 0.63 to 0.89, P=0.001) more than did non-bortezomib maintenance therapy. Our analysis revealed higher incidence of neutropenia (risks ratios (RR) = 1.39; 95% CI = 1.08 to 1.79), peripheral neuropathy (PN) (RR = 2.23; 95% CI = 1.38 to 3.61, P=0.001), and cardiologic events (RR = 1.91; 95% CI = 1.12 to 3.28, P=0.02) in patients with bortezomib maintenance therapy. Our meta-analysis demonstrates OS and PFS benefits of bortezomib maintenance therapy in patients with newly diagnosed MM. However, the therapy is associated with increased risk of adverse events. Additionally, more RCTs are needed for better understanding and determination of optimal bortezomib maintenance therapy in MM.

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