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Successive treatment with cyclosporine and infliximab in steroid-refractory ulcerative colitis

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Abstract
OBJECTIVES: Rescue therapy with either cyclosporine (CYS) or infliximab (IFX) is an effective option in patients with intravenous steroid-refractory attacks of ulcerative colitis (UC). In patients who fail, colectomy is usually recommended, but a second-line rescue therapy with IFX or CYS is an alternative. The aims of this study were to investigate the efficacy and tolerance of IFX and CYS as a second-line rescue therapy in steroid-refractory UC or indeterminate colitis (IC) unsuccessfully treated with CYS or IFX. METHODS: This was a retrospective survey of patients seen during the period 2000-2008 in the GETAID centers. Inclusion criteria included a delay of <1 month between CYS withdrawal (when used first) and IFX, or a delay of <2 months between IFX (when used first) and CYS, and a follow-up of at least 3 months after inclusion. Time-to-colectomy, clinical response, and occurrence of serious adverse events were analyzed. RESULTS: A total of 86 patients (median age 34 years; 49 males; 71 UC and 15 IC) were successively treated with CYS and IFX. The median (+/-s.e.) follow-up time was 22.6 (7.0) months. During the study period, 49 patients failed to respond to the second-line rescue therapy and underwent a colectomy. The probability of colectomy-free survival (+/-s.e.) was 61.3 +/- 5.3% at 3 months and 41.3 +/- 5.6% at 12 months. A case of fatal pulmonary embolism occurred at 1 day after surgery in a 45-year-old man. Also, nine infectious complications were observed during the second-line rescue therapy. CONCLUSIONS: In patients with intravenous steroid-refractory UC and who fail to respond to CYS or IFX, a second-line rescue therapy may be effective in carefully selected patients, avoiding colectomy within 2 months in two-thirds of them. The risk/benefit ratio should still be considered individually.
Keywords
TERM-FOLLOW-UP, INFLAMMATORY-BOWEL-DISEASE, INTRAVENOUS CYCLOSPORINE, RESCUE THERAPY, SEVERE ATTACKS, POSTOPERATIVE COMPLICATIONS, COLECTOMY, EXPERIENCE, CORTICOSTEROIDS, TRIAL

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Chicago
Leblanc, S, M Allez, P Seksik, B Flourié, Harald Peeters, JL Dupas, G Bouguen, et al. 2011. “Successive Treatment with Cyclosporine and Infliximab in Steroid-refractory Ulcerative Colitis.” American Journal of Gastroenterology 106 (4): 771–777.
APA
Leblanc, S., Allez, M., Seksik, P., Flourié, B., Peeters, H., Dupas, J., Bouguen, G., et al. (2011). Successive treatment with cyclosporine and infliximab in steroid-refractory ulcerative colitis. AMERICAN JOURNAL OF GASTROENTEROLOGY, 106(4), 771–777.
Vancouver
1.
Leblanc S, Allez M, Seksik P, Flourié B, Peeters H, Dupas J, et al. Successive treatment with cyclosporine and infliximab in steroid-refractory ulcerative colitis. AMERICAN JOURNAL OF GASTROENTEROLOGY. 2011;106(4):771–7.
MLA
Leblanc, S, M Allez, P Seksik, et al. “Successive Treatment with Cyclosporine and Infliximab in Steroid-refractory Ulcerative Colitis.” AMERICAN JOURNAL OF GASTROENTEROLOGY 106.4 (2011): 771–777. Print.
@article{1199427,
  abstract     = {OBJECTIVES: Rescue therapy with either cyclosporine (CYS) or infliximab (IFX) is an effective option in patients with intravenous steroid-refractory attacks of ulcerative colitis (UC). In patients who fail, colectomy is usually recommended, but a second-line rescue therapy with IFX or CYS is an alternative. The aims of this study were to investigate the efficacy and tolerance of IFX and CYS as a second-line rescue therapy in steroid-refractory UC or indeterminate colitis (IC) unsuccessfully treated with CYS or IFX.
METHODS: This was a retrospective survey of patients seen during the period 2000-2008 in the GETAID centers. Inclusion criteria included a delay of {\textlangle}1 month between CYS withdrawal (when used first) and IFX, or a delay of {\textlangle}2 months between IFX (when used first) and CYS, and a follow-up of at least 3 months after inclusion. Time-to-colectomy, clinical response, and occurrence of serious adverse events were analyzed.
RESULTS: A total of 86 patients (median age 34 years; 49 males; 71 UC and 15 IC) were successively treated with CYS and IFX. The median (+/-s.e.) follow-up time was 22.6 (7.0) months. During the study period, 49 patients failed to respond to the second-line rescue therapy and underwent a colectomy. The probability of colectomy-free survival (+/-s.e.) was 61.3 +/- 5.3\% at 3 months and 41.3 +/- 5.6\% at 12 months. A case of fatal pulmonary embolism occurred at 1 day after surgery in a 45-year-old man. Also, nine infectious complications were observed during the second-line rescue therapy.
CONCLUSIONS: In patients with intravenous steroid-refractory UC and who fail to respond to CYS or IFX, a second-line rescue therapy may be effective in carefully selected patients, avoiding colectomy within 2 months in two-thirds of them. The risk/benefit ratio should still be considered individually.},
  author       = {Leblanc, S and Allez, M and Seksik, P and Flouri{\'e}, B and Peeters, Harald and Dupas, JL and Bouguen, G and Peyrin-Biroulet, L and Duclos, B and Bourreille, A and Dewit, O and Bouhnik, Y and Michetti, P and Chaussade, S and Saussure, P and Mary, JY and Colombel, JF and L{\'e}mann, M},
  issn         = {0002-9270},
  journal      = {AMERICAN JOURNAL OF GASTROENTEROLOGY},
  keyword      = {TERM-FOLLOW-UP,INFLAMMATORY-BOWEL-DISEASE,INTRAVENOUS CYCLOSPORINE,RESCUE THERAPY,SEVERE ATTACKS,POSTOPERATIVE COMPLICATIONS,COLECTOMY,EXPERIENCE,CORTICOSTEROIDS,TRIAL},
  language     = {eng},
  number       = {4},
  pages        = {771--777},
  title        = {Successive treatment with cyclosporine and infliximab in steroid-refractory ulcerative colitis},
  url          = {http://dx.doi.org/10.1038/ajg.2011.62},
  volume       = {106},
  year         = {2011},
}

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