***Note from CCFA's Patient Education Committee: Although there are many benefits associated with these therapies, patients must be aware of the enhanced risk associated with them, including an increased risk of infections.***

Clinical

Cyclosporine and infliximab switch may prevent colectomy in ulcerative colitis

Last Updated: 2011-03-31 16:29:17 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Patients with intravenous steroid-refractory ulcerative colitis initially unresponsive to rescue treatment with cyclosporine may respond to infliximab and vice versa, according to European researchers.

In a March 8th online paper in the American Journal of Gastroenterology, Dr. Matthieu Allez of Hopital Saint-Louis, Paris, and colleagues note that colectomy is usually recommended in patients who fail steroids and rescue therapy. However, second-line therapy involving the alternative agent has reportedly been of benefit in some patients.

To gain more information, the researchers retrospectively reviewed data on 87 patients with steroid-refractory ulcerative colitis or indeterminate colitis. They had been unsuccessfully treated with cyclosporine then followed by infliximab or unsuccessfully with infliximab followed by cyclosporine. There was no control group.

During a median follow-up of 22.6 months more than half of the patients underwent a colectomy. In 45 patients this was because of medical treatment failure and in the other four because of complications such as acute colonic bleeding.

The probability of colectomy-free survival was 61.3% at 3 months and 41.3% at 12 months. The rate of colectomy was similar whatever agent was used as the first salvage therapy. Concomitant use of immunosuppressants such as azathioprine, in more than half of the patients, was associated with better outcomes.

There was a relatively high rate of complications, with a total of 20 adverse events in 19 patients (22%) after the start of second-line therapy. There was one death due to pulmonary embolism a day after surgery.
The researchers conclude that "the alternative treatment avoided colectomy in a significant fraction of patients." However, they also point out that "the risk/benefit ratio has to be considered in each case, taking into account the risk of increased immunosuppression and of delayed surgery."

SOURCE: http://bit.ly/fAuYva
Am J Gastroenterol 2011.