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P543. Better response rates to anti-TNFα than cyclosporin in steroid refractory acute severe colitis: data from the UK IBD audit

R. Lynch1, A. Protheroe2, M. Roughton2, I. Arnott1, UK IBD Audit Steering Group2, 1NHS Lothian, Gastroenterology, Edinburgh, United Kingdom, 2RCP, CEEU, London, United Kingdom

Background

For over thirty years high dose steroids followed by colectomy if required has been the mainstay of treatment for active ulcerative colitis (UC). Recently we have seen the introduction of second-line medical therapies such as anti-TNFα and cyclosporin with the hope of avoiding the need for surgery if first line medical therapy fails.

Methods

Using a cohort of UC patients from round two (2008) and three (2010) of the UK inflammatory bowel disease (IBD) audit respectively we aim to assess the outcomes of patients receiving second-line medical therapies.

We audited 3049 patients with UC from the 2010 round of the UK IBD audit of which 1071 were considered to have acute severe UC (ASUC). 202 Sites audited a median of 18 UC patients per site that were admitted with IBD between 1/09/09 and 31/08/10.

The results of this were compared against the results from the 2008 UK IBD audit which collected data on 2981 UC patients of which there were 863 with ASUC. 209 sites audited a median of 17 UC patients per site that were admitted with IBD between 1/09/07 and 31/08/08.

Results

Between rounds there was no significant change in mortality in the ASUC population, 1.2% (10/863) in 2008 vs 0.7% (7/1071) in 2010 (p < 0.3) additionally response rates to first line steroids were similar between rounds 61.1% (498/815) in 2008 vs 58.8% (602/1024) in 2010 (p < 0.4).

Significantly more patients are receiving second-line medical therapy 47.3% (150/317) in 2008 vs 57.6% (243/422) in 2010 (p < 0.01). Of the patients failing first line therapy significantly less underwent surgery in 2010: 51.4% (163/317) vs 41.0% (173/422) (p < 0.005).

The response rates to anti-TNFα were significantly better than to cyclosporin in both rounds: 75% (39/52) vs 45.9% (45/98) in 2008 (p < 0.005); 81.4% (79/97) vs 60.3% (88/146) in 2010 (p < 0.005). There was a significant difference in response rates to cyclosporin between rounds 45.9% (45/98) in 2008 vs 60.3% (88/146) in 2010 (p < 0.03). Among patients receiving second-line medical therapies there was no significant difference in mortality either between treatments or rounds.

Conclusion

In this unselected population, patients consistently respond significantly better to anti-TNFα than cyclosporin. There has been a significant increase in the number of patients receiving rescue medical therapy and an overall decrease in the number of patients receiving rescue surgery. Interestingly, response rates to cyclosporin are improving which could be a reflection of more established protocols for its use.