P423. Long term outcome for sequential rescue treatments in steroid refractory ulcerative colitis - a real life experience
M. Protic1, F. Seibold2, A. Shoepfer3, Z. Radojicic4, P. Juillerat5, D. Bojic1, J. Mwinyi6, C. Mottet7, N. Jojic1, C. Beglinger8, S. Vavricka9, G. Rogler6, P. Frei10, 1University Hospital Zvezdara, Department of Gastroenterology, Belgrade, Serbia, 2Tiefenau Spital, Department of Gastroenterology, Bern, Switzerland, 3Centre Hospitalier Universitaire Vaudois, Gastroenterology, Lausanne, Switzerland, 4Faculty of Organizational Sciences, Department of Statistics, Belgrade, Serbia, 5University Hospital Bern, Gastroenterology and Hepatology, Bern, Switzerland, 6University Hospital Zurich, Gastroenterology & Hepatology, Zurich, Switzerland, 7Hospital Neuchâtel, Department of Gastroenterology, Neuchâtel, Switzerland, 8University Hospital Basel, Division of Gastroenterology & Hepatology, Basel, Switzerland, 9Stadtspital Triemli, Department of Gastroenterology, Zürich, Switzerland, 10See Spital, Department of Gastroenterology, Zürich, Switzerland
Patients with moderate to severe steroid refractory ulcerative colitis (UC) who failed rescue therapy with either calcineurin inhibitors or Infliximab (IFX) have limited medical options to avoid colectomy. Although sequential salvage therapy has been associated with high incidence of complications, many patients prefer to have additional medical therapy than to undergo colectomy. AIM: To evaluate remission and adverse event rates of a second or third line rescue therapy over a one-year period.
Response to single or sequential rescue treatments with Infliximab (5 mg/kg intravenously at week 0, 2, 6 and then every 8 weeks), Cyclosporine (iv CsA 2 mg/kg/daily and then oral CsA 5 mg/kg/daily) or Tacrolimus (0.05 mg/kg divided in 2 doses, aiming for serum trough levels of 7–12 ng/mL) in patients with steroid-refractory moderate to severe ulcerative colitis, was retrospectively studied in a cohort of 108 patients. The endpoints were one year corticosteroid free remission rate and adverse event rates.
Out of 108 patients initially treated with a first line rescue therapy, 32% patients (35/108) achieved and maintained corticosteroid (CS) free remission over a year; out of 40% (43/108) who failed to respond to 1st line therapy, 11 went to colectomy and 32 patients were switched to 2nd line rescue treatment. One year CS free remission rate in this group was 19% (6/32). 11 patients from this group failed to respond, 5 went to colectomy while 6 of them were switched to a third line rescue treatment. In the latter group, only 1 patient (18%) achieved and maintained CS free remission rate during 1 year. Overall, colectomy rate of the whole cohort after three rescue treatments was 18%, while steroid-free remission rate was 39%. The adverse event rates were 33%, 37.5% and 30% for the first, second and third line treatment respectively. We observed 7.5% (8/108) severe adverse events including 1 death after single rescue therapy with CsA.
According to our data, it seems that intervention with 2nd or even 3rd rescue treatment led to modest improvement of the remission rate. Despite the decrease of colectomy frequency a longer follow-up will be necessary to investigate whether intervention with sequential therapy will only delay colectomy and what percentage of patients will remain in a long-term remission.