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P523. Cyclosporin rescue therapy is as effective as infliximab at preventing colectomy

S. O'Connor1,2, M. Lalji1, G. Holtmann1,2, P. Pillans2,3, N. Martin1, D. Burger1, 1Princess Alexandra Hospital, Gastroenterology, Brisbane, Australia, 2University of Queensland, Gastroenterology, Brisbane, Australia, 3Princess Alexandra Hospital, Clincal Pharmacology, Brisbane, Australia

Background

Acute severe colitis is a medical emergency with significant mortality and morbidity. Rescue therapy for steroid-refractory acute severe colitis (ACS), with either Cyclosporin or Infliximab, is debated, and depends not only on efficacy and safety, but also cost considerations. This study reviews the outcomes of both Cyclosporin and Infliximab in patients with steroid-refractory ACS at our institution.

Methods

Consecutive patients receiving Cyclosporin or Infliximab rescue therapy at the Princess Alexandra Hospital, between January 2007 and September 2013 were included. Acute severe colitis was defined by the Truelove and Witts criteria. Colectomy rates were assessed at 7, 30, 90 days and 12 months. In addition to this, length of hospital stay and adverse drug reactions (ADR) were evaluated.

Results

28 patients were identified, 13 Cyclosporin and 15 Infliximab patients, these groups did not differ in regards to median age, sex, duration of disease or extent, extraintestinal manifestations, previous immunomodular therapy, median CRP, haemoglobin or albumin at admission. Number of Truelove and Witts criteria at admission were similar between groups. There were 2 (15%) ADR in the Cyclosporin group (renal impairment and tremors) and 1 (6%) in the Infliximab group (abscess formation) (p = 0.58). Colectomy rates collated with the severity of disease at presentation. 25% of patients with one Truelove and Witts criteria required colectomy whereas 76% of those with ≥2 criteria proceeded to colectomy (p = 0.001). Colectomy free rates in Cyclosporin and Infliximab groups were not different at day 7 (85% and 93%;p = 0.58), day 30 (54% and 73%; p = 0.43), day 90 (46% and 60%;p = 0.71) and 12 months (46% and 47%;p = 1.0). The mean number of days in hospital in the 90 days post rescue therapy in the Cyclosporin and Infliximab groups was 16.3 and 12.6 (p = 0.40). Two patients where treated sequentially with both Cyclosporin and Infliximab, both of these patients underwent colectomy within 90 days.

Conclusion

Biological severity at presentation is directly associated with the need for surgical intervention. Colectomy free survival and length of stay were equivalent for Infliximab and Cyclosporin.