P365 Direct rescue treatment is justified in moderate flares of Ulcerative Colitis worsening with oral corticosteroid therapy
J. Llaó*1, J. E. Naves2, A. Ruiz-Cerulla3, J. Gordillo4, M. Mañosa2, C. Arajol3, E. Cabre5, J. Guardiola3, E. Garcia-Planella4, E. Domenech2
1Hospital de la Santa Creu i de Sant Pau, Inflamatory bowel disease, Barcelona, Spain, 2Hospital Germans Trias i Pujol, Gastroenterology, Badalona, Spain, 3Hospital de Bellvitge. Idibell, Gastroenterology, Barcelona, Spain, 4Hospital de la Santa Creu i Sant Pau, Gastroenterology, Barcelona, Spain, 5Hospital germans Trias i Pujol, Gastroenterology, Barcelona, Spain
: Intravenous corticosteroids (CS) are the treatment of choice for severe attack of ulcerative colitis (UC). Response to CS therapy can be assessed by simple clinical and biological parameters as soon as 3-5 day of initial treatment. The availability of predictive factors of response to steroid treatment allows the early introduction of rescue treatments. This fact can explain, at less in part, the fall in the colectomy incidence rate in this setting. Aims: To identify clinical and/or biological parameters at the moment to star CS therapy for a severe attack of UC associated with rescue treatment needed.
All UC patients admitted to three University hospitals between January 2005 and December 2011 were identified from electronic databases. Disease severity was defined according to the Montreal classification, and only patients with severe UC treated with intravenous CS were included. Demographic and epidemiological data were recorded, as well as clinical and biological parameters used to define severe attack (number of bowel movements, protein C reactive, hemoglobin, fever, tachycardia or hypotension).
A total of 62 flares were included, 70% extensive disease, 82% not current smoking. 43% of flares required rescue treatment during hospital admission. 10 of the 14 flares (71%) who have been previously treated with oral CS for the index flare before starting intravenous CS required rescue treatment during hospital admission and 3 who didn't need rescue treatment become dependent to CS in the follow-up. In univariate analysis, not responding to oral CS in the index flare, not tobacco exposure, the absence of systemic symptoms or to have less of two severe criteria were associated to need of rescue treatment. In multivariate analysis only not response to oral CS for the index flare was an independent predictor of rescue treatment needed (HR XX, IC 95% xx-xx; P=0,018).
In sever attacks of UC, the only predictor factor associated to rescue treatment needed was the failure of oral CS for the index flare. This data suggest that patients with clinical worsening during oral CS therapy for a moderate flare of UC are candidate to direct rescue treatment with cyclosporine or infliximab without attempting the intravenous route of CS.