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Infliximab or cyclosporine as rescue therapy in hospitalized patients with steroid-refractory ulcerative colitis: A retrospective observational study

Sjoberg, Mats; Walch, Andrea; Meshkat, Mina; Gustavsson, Anders; Jarnerot, Gunnar; Vogelsang, Harald; Hertervig, Erik LU ; Novacek, Gottfried; Friis-Liby, Ingalill and Blomquist, Lars, et al. (2012) In Inflammatory Bowel Diseases 18(2). p.212-218
Abstract
Background: Cyclosporine (CsA) or infliximab (IFX) are used as rescue therapies in steroid-refractory, severe attacks of ulcerative colitis (UC). There are no data comparing the efficacy of these two alternatives. Methods: Outcome of rescue therapy was retrospectively studied in two cohorts of patients hospitalized due to steroid-refractory moderate to severe UC: 1) a Swedish-Danish cohort (n 49) treated with a single infusion of IFX; 2) an Austrian cohort (n 43) treated with intravenous CsA. After successful rescue therapy, maintenance immunomodulator treatment was given to 27/33 (82%) of IFX patients and to 31/40 (78%) of CsA patients. Endpoints were colectomy-free survival at 3 and 12 months. Kaplan-Meier and Cox regression models were... (More)
Background: Cyclosporine (CsA) or infliximab (IFX) are used as rescue therapies in steroid-refractory, severe attacks of ulcerative colitis (UC). There are no data comparing the efficacy of these two alternatives. Methods: Outcome of rescue therapy was retrospectively studied in two cohorts of patients hospitalized due to steroid-refractory moderate to severe UC: 1) a Swedish-Danish cohort (n 49) treated with a single infusion of IFX; 2) an Austrian cohort (n 43) treated with intravenous CsA. After successful rescue therapy, maintenance immunomodulator treatment was given to 27/33 (82%) of IFX patients and to 31/40 (78%) of CsA patients. Endpoints were colectomy-free survival at 3 and 12 months. Kaplan-Meier and Cox regression models were used to evaluate the association between treatment groups and colectomy. Results: At 15 days, colectomy-free survival in the IFX cohort was 36/49 (73%) versus 41/43 (95%) in the CsA cohort (P = 0.005), at 3 months 33/49 (67%) versus 40/43 (93%) (P = 0.002), and at 12 months 28/49 (57%) versus 33/43 (77%) (P = 0.034). After adjusting for potential confounding factors, Cox regression analysis yielded adjusted hazard ratios for risk of colectomy in IFX-treated patients of 11.2 (95% confidence interval [CI] 2.4-53.1, P = 0.002) at 3 months and of 3.0 (95% CI 1.1-8.2, P = 0.030) at 12 months in comparison with CsA-treated patients. There were no opportunistic infections or mortality. Conclusions: Colectomy frequencies were significantly lower after rescue therapy with CsA than with a single infusion of IFX both at 3 and 12 months' follow-up. The superiority of CsA was seen principally during the first 15 days. (Less)
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publication status
published
subject
keywords
ulcerative colitis, cyclosporine, infliximab, rescue therapy, colectomy
in
Inflammatory Bowel Diseases
volume
18
issue
2
pages
212 - 218
publisher
John Wiley & Sons
external identifiers
  • wos:000298957800004
  • scopus:84855698480
ISSN
1536-4844
DOI
10.1002/ibd.21680
language
English
LU publication?
yes
id
415a4f02-697b-454a-8598-6c35df751730 (old id 2355238)
date added to LUP
2012-03-01 11:27:43
date last changed
2017-08-20 03:23:03
@article{415a4f02-697b-454a-8598-6c35df751730,
  abstract     = {Background: Cyclosporine (CsA) or infliximab (IFX) are used as rescue therapies in steroid-refractory, severe attacks of ulcerative colitis (UC). There are no data comparing the efficacy of these two alternatives. Methods: Outcome of rescue therapy was retrospectively studied in two cohorts of patients hospitalized due to steroid-refractory moderate to severe UC: 1) a Swedish-Danish cohort (n 49) treated with a single infusion of IFX; 2) an Austrian cohort (n 43) treated with intravenous CsA. After successful rescue therapy, maintenance immunomodulator treatment was given to 27/33 (82%) of IFX patients and to 31/40 (78%) of CsA patients. Endpoints were colectomy-free survival at 3 and 12 months. Kaplan-Meier and Cox regression models were used to evaluate the association between treatment groups and colectomy. Results: At 15 days, colectomy-free survival in the IFX cohort was 36/49 (73%) versus 41/43 (95%) in the CsA cohort (P = 0.005), at 3 months 33/49 (67%) versus 40/43 (93%) (P = 0.002), and at 12 months 28/49 (57%) versus 33/43 (77%) (P = 0.034). After adjusting for potential confounding factors, Cox regression analysis yielded adjusted hazard ratios for risk of colectomy in IFX-treated patients of 11.2 (95% confidence interval [CI] 2.4-53.1, P = 0.002) at 3 months and of 3.0 (95% CI 1.1-8.2, P = 0.030) at 12 months in comparison with CsA-treated patients. There were no opportunistic infections or mortality. Conclusions: Colectomy frequencies were significantly lower after rescue therapy with CsA than with a single infusion of IFX both at 3 and 12 months' follow-up. The superiority of CsA was seen principally during the first 15 days.},
  author       = {Sjoberg, Mats and Walch, Andrea and Meshkat, Mina and Gustavsson, Anders and Jarnerot, Gunnar and Vogelsang, Harald and Hertervig, Erik and Novacek, Gottfried and Friis-Liby, Ingalill and Blomquist, Lars and Angelberger, Sieglinde and Karlen, Per and Granno, Christer and Vilien, Mogens and Strom, Magnus and Verbaan, Hans and Hellstrom, Per M. and Dejaco, Clemens and Magnuson, Anders and Halfvarson, Jonas and Reinisch, Walter and Tysk, Curt},
  issn         = {1536-4844},
  keyword      = {ulcerative colitis,cyclosporine,infliximab,rescue therapy,colectomy},
  language     = {eng},
  number       = {2},
  pages        = {212--218},
  publisher    = {John Wiley & Sons},
  series       = {Inflammatory Bowel Diseases},
  title        = {Infliximab or cyclosporine as rescue therapy in hospitalized patients with steroid-refractory ulcerative colitis: A retrospective observational study},
  url          = {http://dx.doi.org/10.1002/ibd.21680},
  volume       = {18},
  year         = {2012},
}