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Severe ulcerative colitis: predictors of response and algorithm proposal for rescue therapy

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Abstract

Background

There is no agreeing if rescue therapy can avoid short-term colectomy in patients treated for severe steroid-refractory ulcerative colitis.

Aims

The aim of our study was to identify predictors of response to infliximab and cyclosporine A.

Methods

In this cross-sectional study, 49 patients with severe ulcerative colitis were included. Response to therapy was defined as three or more point reductions in Mayo score after 6 months of treatment and avoidance of colectomy after 1 year. The predictors analysed were gender, age, time from ulcerative colitis diagnosis, months of steroid or/and azathioprine therapy before onset of the severe phase, smoking habits, extension of the disease, laboratory analyses and Mayo score.

Results

Patients treated with infliximab showed a statistically significant higher response rate in case of moderate Mayo score (P = 0.04). Ex-smokers had very low chance of response to infliximab (P = 0.03). In the group treated with cyclosporine A, patients with C-reactive protein >3 mg/L had a response rate significantly higher than those with C-reactive protein <3 mg/L (P = 0.03); those with negative C-reactive protein and moderate Mayo score did not responded to therapy, while in the ones with elevated C-reactive protein and/or severe Mayo score, 15 versus 4 responded (P = 0.008).

Conclusions

Our data suggest that cyclosporine A is advisable in ex-smokers. In never smokers or active smokers, infliximab can be prescribed in case of Mayo score ≤10 and/or negative CRP, while cyclosporine A is indicated in case of Mayo score >10 and positive CRP.

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Author notes

  1. D. G. Ribaldone and I. Dileo equally contributed to this paper.

Authors and Affiliations

  1. Gastroenterology-U, General and Specialist Medicine Department, Città della Salute e della Scienza of Turin, C.so Bramante 88, 10126, Turin, Italy

    D. G. Ribaldone

  2. Department of Gastroenterology and Hepatology, Molinette Hospital-S.G.A.S, Via Cavour 31, 10123, Turin, Italy

    D. G. Ribaldone

  3. Unit of Gastroenterology and Hepatology, Molinette Hospital, 10126, Turin, Italy

    I. Dileo, R. Pellicano, M. Vernero & M. Astegiano

  4. Fourth General Surgery Department, Città della Salute e della Scienza, Azienda Ospedaliera ed Universitaria, 10126, Turin, Italy

    A. Resegotti

  5. Institute for Biostructures and Bioimages-CNR c/o Molecular Biotechnology Center, University of Torino, 10126, Turin, Italy

    S. Fagoonee

  6. Department of Medical Sciences, University of Torino, 10126, Turin, Italy

    G. Saracco

Authors
  1. D. G. Ribaldone
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  2. I. Dileo
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  3. R. Pellicano
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  4. A. Resegotti
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  5. S. Fagoonee
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  6. M. Vernero
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  7. G. Saracco
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  8. M. Astegiano
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Contributions

Saracco G, Astegiano M, Pellicano R, Dileo I and Ribaldone DG designed the research; Dileo I, Fagoonee S and Vernero M performed the research; Vernero M and Fagoonee S analysed the data; Dileo I GA, Ribaldone DG, Astegiano M and Pellicano R wrote the paper. All authors have approved the final article.

Corresponding author

Correspondence to D. G. Ribaldone.

Ethics declarations

This article does not contain any studies with human participants performed by any of the authors. Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Supported by: None.

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Ribaldone, D.G., Dileo, I., Pellicano, R. et al. Severe ulcerative colitis: predictors of response and algorithm proposal for rescue therapy. Ir J Med Sci 187, 385–392 (2018). https://doi.org/10.1007/s11845-017-1666-0

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  • DOI: https://doi.org/10.1007/s11845-017-1666-0

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