Successive treatment with cyclosporine and infliximab in steroid-refractory ulcerative colitis. - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue The American Journal of Gastroenterology Année : 2011

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

S. Leblanc
  • Fonction : Auteur
M. Allez
  • Fonction : Auteur
B. Flourié
  • Fonction : Auteur
  • PersonId : 886942
H. Peeters
  • Fonction : Auteur
J. L. Dupas
  • Fonction : Auteur
G. Bouguen
  • Fonction : Auteur
L. Peyrin-Biroulet
O. Dewit
  • Fonction : Auteur
Y. Bouhnik
P. Michetti
  • Fonction : Auteur
S. Chaussade
  • Fonction : Auteur
P. Saussure
  • Fonction : Auteur
J. Y. Mary
  • Fonction : Auteur
J. F. Colombel
  • Fonction : Auteur
Non Renseigné
  • Fonction : Auteur

Résumé

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.

Domaines

Chimie organique
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Dates et versions

hal-00629687 , version 1 (06-10-2011)

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Citer

S. Leblanc, M. Allez, P. Seksik, B. Flourié, H. Peeters, et al.. Successive treatment with cyclosporine and infliximab in steroid-refractory ulcerative colitis.. The American Journal of Gastroenterology, 2011, 106 ((4)), pp.771-7. ⟨10.1038/ajg.2011.62⟩. ⟨hal-00629687⟩
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