Original article—alimentary tractCyclosporine and Infliximab as Rescue Therapy for Each Other in Patients With Steroid-Refractory Ulcerative Colitis
Section snippets
Patients
We retrospectively reviewed the records of patients with severe UC who had failed either intravenous steroids at a dose equivalent to at least 60 mg/d of prednisone, or patients who had failed at least one course of oral prednisone at a minimum dose of 40 mg/d for 2 weeks. We identified those patients who received cyclosporine first and then infliximab as acute salvage therapy (IFX-salvage), or who failed infliximab first and then received cyclosporine as acute salvage therapy (CSA-salvage).
Patient Demographics
Nineteen patients, 9 men and 10 women, underwent acute salvage therapy with either cyclosporine or infliximab within 4 weeks of discontinuing the other. Demographic data are shown in Table 2. Ten patients who failed cyclosporine were treated with infliximab as acute salvage therapy (IFX-salvage group), 9 patients who failed infliximab received cyclosporine as acute salvage therapy (CSA-salvage group). In all patients, the reason for switching to cyclosporine or infliximab was failure to achieve
Discussion
Patients with severe ulcerative colitis who fail high-dose corticosteroids have limited medical options to achieve remission and avoid colectomy. Patients often are referred to our center because they are reluctant to undergo colectomy and are seeking additional medical therapy. This is primarily owing to known complications of J-pouch surgery, including frequent bowel movements, incontinence, decreased fecundity, and others.13
We found that in patients who failed to achieve remission with
References (16)
- et al.
Intravenous cyclosporin in ulcerative colitis: a five-year experience
Am J Gastroenterol
(1999) - et al.
Preliminary report: cyclosporin in treatment of severe active ulcerative colitis
Lancet
(1990) - et al.
Randomized, double-blind comparison of 4 mg/kg versus 2 mg/kg intravenous cyclosporine in severe ulcerative colitis
Gastroenterology
(2003) - et al.
Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study
Gastroenterology
(2005) - et al.
Association of trough serum infliximab to clinical outcome after scheduled maintenance treatment for Crohn's disease
Clin Gastroenterol Hepatol
(2006) - Actis GC, Fadda M, David E, et al. Colectomy rate in steroid-refractory colitis initially responsive to cyclosporin: a...
- et al.
Cyclosporine in severe ulcerative colitis refractory to steroid therapy
N Engl J Med
(1994) - et al.
Treatment of ulcerative colitis refractory to steroid therapy by oral microemulsion cyclosporine (neoral)
Inflamm Bowel Dis
(2006)
Cited by (155)
Are we choosing wisely for inflammatory bowel disease care? The IG-IBD choosing wisely campaign
2020, Digestive and Liver DiseaseSafety and Efficacy of Combination Treatment With Calcineurin Inhibitors and Vedolizumab in Patients With Refractory Inflammatory Bowel Disease
2019, Clinical Gastroenterology and HepatologyCitation Excerpt :One hazard of multi-agent immunomodulator therapy in patients with IBD has been infection and other adverse events related to profound immune suppression.8,24 In fact, combination therapy with a calcineurin inhibitor and anti-TNF therapy has been relatively contraindicated owing to severe infection risk and even mortality.17 However, the predominantly gut-selective effect of vedolizumab on immune reactivity and minimal side effects and infection risk associated with its use as a monotherapy may imply that the addition of a systemically acting agent with broad immune-suppressing effects would not carry infective and other complications greater than that of the individual drugs.
Effectiveness and safety of a third-line rescue treatment for acute severe ulcerative colitis refractory to infliximab or ciclosporin (REASUC study)
2024, Alimentary Pharmacology and TherapeuticsReview article: Updated management of acute severe ulcerative colitis: From steroids to novel medical strategies
2023, United European Gastroenterology JournalGastrointestinal manifestations in COVID-19
2023, Critical Care and COVID-19In-hospital management of inflammatory bowel disease
2023, Current Opinion in Gastroenterology
E.A.M., D.D., and D.H.P. have no conflicts of interest to disclose; S.L. received research grants from Centocor (not for this project); T.U. received speaking and consulting fees from Abbott, Centocor, and UCB Pharmaceuticals; and A.K. received advisory board and speaking fees from Abbott, Centocor, and UCB Pharmaceuticals. Potential investigator conflicts of interest were not disclosed to subjects (study participants); they were disclosed to all authors involved.