Infliximab or cyclosporine as rescue therapy in hospitalized patients with steroid-refractory ulcerative colitis: A retrospective observational study

Research output: Contribution to journalArticle

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.

Details

Authors
  • Mats Sjoberg
  • Andrea Walch
  • Mina Meshkat
  • Anders Gustavsson
  • Gunnar Jarnerot
  • Harald Vogelsang
  • Gottfried Novacek
  • Ingalill Friis-Liby
  • Lars Blomquist
  • Sieglinde Angelberger
  • Per Karlen
  • Christer Granno
  • Mogens Vilien
  • Magnus Strom
  • Hans Verbaan
  • Per M. Hellstrom
  • Clemens Dejaco
  • Anders Magnuson
  • Jonas Halfvarson
  • Walter Reinisch
  • Curt Tysk
Organisations
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Gastroenterology and Hepatology

Keywords

  • ulcerative colitis, cyclosporine, infliximab, rescue therapy, colectomy
Original languageEnglish
Pages (from-to)212-218
JournalInflammatory Bowel Diseases
Volume18
Issue number2
Publication statusPublished - 2012
Publication categoryResearch
Peer-reviewedYes