Infliximab as a Rescue Therapy for Hospitalized Patients with Severe Ulcerative Colitis Refractory to Systemic Corticosteroids

2008 ◽  
Vol 25 (5) ◽  
pp. 383-386 ◽  
Author(s):  
Jesús K. Yamamoto-Furusho ◽  
Luis F. Uzcanga
Keyword(s):  
Ulcerative Colitis ◽  
Rescue Therapy ◽  
Hospitalized Patients ◽  
Severe Ulcerative Colitis ◽  
Systemic Corticosteroids

scholarly journals The Use of Infliximab for Treatment of Hospitalized Patients with Acute Severe Ulcerative Colitis

2008 ◽  
Vol 22 (11) ◽  
pp. 937-940 ◽  
Author(s):  
B Bressler ◽  
JK Law ◽  
N Al Nahdi Sheraisher ◽  
K Atkinson ◽  
MF Byrne ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Life Experience ◽  
Rescue Therapy ◽  
Real Life ◽  
Case Series ◽  
Hospitalized Patients ◽  
Severe Ulcerative Colitis ◽  
Duration Of Disease ◽  
Intravenous Steroids ◽  
Steroid Refractory

BACKGROUND/AIM: The use of infliximab in severe ulcerative colitis (UC) is established; however, its role in severe acute UC requires clarification. The present multicentre case series evaluated infliximab in hospitalized patients with steroid-refractory severe UC.METHODS: Patients from six hospitals were retrospectively evaluated. Data collection included demographics, duration of disease and previous treatments. The primary end point was response to in-hospital infliximab; defined as discharge without colectomy.RESULTS: Twenty-one patients (median age 26 years) were admitted between May 2006 and May 2008 with severe UC requiring intravenous steroids and given infliximab (median time to infusion eight days). Sixteen (76%) patients were discharged home without colectomy; three of these underwent colectomy at a later date. Of the remaining 13 patients (62%), all but two did not require further courses of steroids; six patients had infliximab as a bridge to azathioprine and seven patients were maintained on regular infliximab. Five patients required in-hospital colectomy after the initial infliximab.CONCLUSIONS: In this real-life experience of infliximab in patients with steroid-refractory severe UC, infliximab appears to be a viable rescue therapy. The majority of patients were discharged without surgery and 62% maintained response either as a bridge to azathioprine or maintenance infliximab.

scholarly journals Acute severe ulcerative colitis: management advice for internal medicine and emergency physicians

2021 ◽  
Author(s):  
Konstantina Rosiou ◽  
Christian Philipp Selinger
Keyword(s):  
Ulcerative Colitis ◽  
Rescue Therapy ◽  
Medical Emergency ◽  
Close Monitoring ◽  
Surgical Morbidity ◽  
Severe Ulcerative Colitis ◽  
General Management ◽  
Management Measures ◽  
Management Advice ◽  
Team Setting

AbstractAcute severe ulcerative colitis is a medical emergency that warrants in-patient management. This is best served within a multidisciplinary team setting in specialised centres or with expert consultation. Intravenous corticosteroids remain the cornerstone in the management of ASUC and should be initiated promptly, along with general management measures and close monitoring of patients. Unfortunately, one-third of patients will fail to respond to steroids. Response to intravenous corticosteroid therapy needs to be assessed on the third day and rescue therapies, including cyclosporine and infliximab, should be offered to patients not responding. Choice of rescue therapy depends on experience, drug availability and factors associated with each individual patient, such as comorbidities, previous medications or contra-indications to therapy. Patients who have not responded within 7 days to rescue therapy must be considered for surgery. Surgery is a treatment option in ASUC and should not be delayed in cases of failure of medical therapy, because such delays increase surgical morbidity and mortality. This review summarises the current management of acute severe ulcerative colitis and discusses potential future developments.

scholarly journals Tofacitinib: An Option for Acute Severe Ulcerative Colitis?

2021 ◽  
pp. 1-3
Author(s):  
Sara Santos ◽  
Verónica Gamelas ◽  
Rita Saraiva ◽  
Guilherme Simões ◽  
Joana Saiote ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Improvement ◽  
Rescue Therapy ◽  
New Drugs ◽  
Multiple Drug ◽  
Disease Course ◽  
Efficacy And Safety ◽  
Severe Ulcerative Colitis ◽  
Rapid Absorption

Tofacitinib has emerged as a new option for ulcerative colitis. Its rapid absorption, metabolism, and clinical improvement make it an interesting option for rescue therapy in acute severe ulcerative colitis (ASUC), a situation with limited therapeutic options in patients with a long-term disease course and multiple drug failure. The management of ASUC in this setting becomes challenging, underlying the need for new drugs and data on their efficacy and safety. We describe 2 cases of acute episodes in which tofacitinib was used as a rescue therapy.

scholarly journals Long-term outcomes of acute severe ulcerative colitis in the rescue therapy era: A multicentre cohort study

2020 ◽  
pp. 205064062097740
Author(s):  
Stefano Festa ◽  
Maria L Scribano ◽  
Daniela Pugliese ◽  
Cristina Bezzio ◽  
Mariabeatrice Principi ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Tumour Necrosis ◽  
Rescue Therapy ◽  
Tumour Necrosis Factor Alpha ◽  
Necrosis Factor Alpha ◽  
Severe Ulcerative Colitis ◽  
Factor Alpha ◽  
Necrosis Factor

Background The long-term course of ulcerative colitis after a severe attack is poorly understood. Second-line rescue therapy with cyclosporine or infliximab is effective for reducing short-term colectomy but the impact in the long-term is controversial. Objective The purpose of this study was to evaluate the long-term course of acute severe ulcerative colitis patients who avoid early colectomy either because of response to steroids or rescue therapy. Methods This was a multicentre retrospective cohort study of adult patients with acute severe ulcerative colitis admitted to Italian inflammatory bowel disease referral centres from 2005–2017. All patients received intravenous steroids, and those who did not respond received either rescue therapy or colectomy. For patients who avoided early colectomy (within three months from the index attack), we recorded the date of colectomy, last follow-up visit or death. The primary end-point was long-term colectomy rate in patients avoiding early colectomy. Results From the included 372 patients with acute severe ulcerative colitis, 337 (90.6%) avoided early colectomy. From those, 60.5% were responsive to steroids and 39.5% to the rescue therapy. Median follow-up was 44 months (interquartile range, 21–85). Colectomy-free survival probability was 93.5%, 81.5% and 79.4% at one, three and five years, respectively. Colectomy risk was higher among rescue therapy users than in steroid-responders (log-rank test, p = 0.02). At multivariate analysis response to steroids was independently associated with a lower risk of long-term colectomy (adjusted odds ratio = 0.5; 95% confidence interval, 0.2–0.8), while previous exposure to anti-tumour necrosis factor alpha agents was associated with an increased risk (adjusted odds ratio = 3.0; 95% confidence interval, 1.5–5.7). Approximately 50% of patients required additional therapy or new hospitalization within five years due to a recurrent flare. Death occurred in three patients (0.9%). Conclusions Patients with acute severe ulcerative colitis avoiding early colectomy are at risk of long-term colectomy, especially if previously exposed to anti-tumour necrosis factor alpha agents or if rescue therapy during the acute attack was required because of steroid refractoriness.

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