P417. Managing pediatric acute severe ulcerative colitis according to the 2011 ECCO-ESPGHAN Guidelines: Efficacy of infliximab as a rescue therapy
G. D'Arcangelo, G. Di Nardo, M. Capponi, F. Nuti, F. Vassallo, F. Civitelli, F. Viola, S. Cucchiara, M. Aloi, Sapienza University of Rome, Pediatrics, Rome, Italy
Acute severe ulcerative colitis (ASC) is a potentially life-threatening event. Scarce pediatric data are available about success rates of Infliximab (IFX) as a second line therapy. This study was performed in consecutively observed pediatric patients with ASC and aimed at assessing the long-term efficacy of IFX and clinical predictors of poor outcome. Patients had been recruited, after reporting of the 2011 ECCO-ESPGHAN guidelines on pediatric ASC .
Children who experienced an episode of ASC, defined as a PUCAI of at least 65 points, were evaluated. Clinical assessment through PUCAI and laboratory data (ESR, CRP, hemoglobin, albumin, hematocrit, ferritin) were recorded at admission and at day 3 and 5. All patients were treated according to the above mentioned guidelines for ASC and received intravenous (iv) corticosteroids (CS). IFX was administered as second-line therapy in CS-refractory patients. In a 2-year follow up we assessed the overall colectomy rate and efficacy of IFX.
Thirty-one patients (age: 10.6±4.88, 52% female) met the criteria for ASC: 21 (68%) responded to iv CS, while 10 (32%) received IFX for CS-refractoriness. Among the latter, 2 (20%) underwent urgent colectomy; however, at a 2-year follow up, 5 (50%) needed elective colectomy, while only 3 of the CS-responders required surgery (14%). Compared to CS-responsive patients, those CS refractory showed a significantly shorter interval from the diagnosis of ulcerative colitis to the episode of ASC (p = 0.04) and a higher rate of colectomy at maximum follow-up (p = 0.007). Patients needing colectomy differentiated from those responding to medical therapy for more frequent courses of CS prior to ASC (p = 0.02), but not for laboratory values, sex, disease location, disease extension, therapy, mean PUCAI, serological markers and family history.
Although its short-term effectiveness as a rescue therapy to avoid urgent colectomy in CS-refractory children, IFX does not modify the long term colectomy rate in ASC. Frequent courses of CS are predictive of a poor long-term outcome.
1. Turner D, (2011), Consensus for Managing Acute Severe Ulcerative Colitis in Children: A Systematic Review and Joint Statement From ECCO, ESPGHAN, and the Porto IBD Working Group of ESPGHAN, Am J Gastroenterol, 106, 574–588.