Infliximab or cyclosporine as rescue therapy in hospitalized patients with steroid-refractory ulcerative colitis: A retrospective observational study
(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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https://lup.lub.lu.se/record/2355238
- author
- organization
- publishing date
- 2012
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- ulcerative colitis, cyclosporine, infliximab, rescue therapy, colectomy
- in
- Inflammatory Bowel Diseases
- volume
- 18
- issue
- 2
- pages
- 212 - 218
- publisher
- Oxford University Press
- external identifiers
-
- wos:000298957800004
- scopus:84855698480
- pmid:21438096
- 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
- 2016-04-01 11:00:25
- date last changed
- 2024-01-22 04:18:26
@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}},
keywords = {{ulcerative colitis; cyclosporine; infliximab; rescue therapy; colectomy}},
language = {{eng}},
number = {{2}},
pages = {{212--218}},
publisher = {{Oxford University Press}},
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}},
doi = {{10.1002/ibd.21680}},
volume = {{18}},
year = {{2012}},
}