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P506. Follow-up of ulcerative colitis patients after a first course of endovenous corticosteroids

A. Hernandez Camba1, N. Hernandez Alvarez-Buylla1, N. Garcia Borges2, I. Alonso1, M. Carrillo1, L. Ramos1, E. Quintero1, 1Hospital Universitario de Canaris, Gastroenterology, La Laguna, Spain, 2Universidad de la Laguna, Facultad de Medicina, La Laguna, Spain

Background

In Ulcerative Colitis (UC), up to 20% of patients treated with corticoids will not respond and the risk of colectomy at 5 years of diagnosis was 7.5% in a recent population-study. The use of immunomodulatory agents (IMM) and anti-TNF (a-TNF) agents may modify the natural history of UC but the predictive factors for a complicated evolution not well known. We proposed to characterize the UC patients after a first course of endovenous corticosteroids ECT in our tertiary center.

Methods

All UC patients admitted to the hospital for an acute flare requiring EC between January 2007 and March 2012 were reviewed. We included only the patients with a first-initial course EC since UC diagnosis time. We defined as “responders” when patients achieved clinical remission in the first seven days of EC and “no responders” when patients needed a rescue therapy because of no clinical response after 7 days of EC. Demographic and clinical features were obtained from the medical records until October 2012.

Results

A total of 41 episodes were collected during this period and 14 (34%) completed inclusion criteria. EC “response” was obtained in 9 patients (9/14; 60%, 5F/4M, mean age 36 years). Half of them (5/9), the diagnosis of UC concurred with the hospitalization and EC therapy. After a median follow-up of 24 months (6–56), 4 patients (44%) needed treatment escalation by using IMM for steroid-dependency and 2 (22%) of them used granulocyte aphaeresis before a-TNF therapy. No surgeries were observed in this group. Five patients were EC “no responders” (5/14; 40%, 4F/1M, mean age 30 years). A-TNF therapy was used in 1 patient and 4 received Cyclosporine A (CyA) for steroid-refractoriness and 3 were newly UC diagnose. One patient underwent total colectomy 10 days after EC beginning without further complication or treatment. After 36 months (5–63), 4 patients started IMM (80%) and 1 started a-TNF (20%) but developed a tuberculosis (TBC) infection and after TBC treatment remained with only IMM therapy. Nowadays, 2 more patients (40%) were considered for a-TNF because steroid-dependency after acute flare (mean time 6 months). No other surgeries were produced during follow-up.

Conclusion

In our center, about half of patients developed a “no responder” to EC flare and most of them will need a-TNF for maintenance therapy even after use of CyA treatment mainly because of steroid-dependence. Even when the UC patients respond to EC, about 40% of them require IMM and even a-TNF for again for steroid-dependence.