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P539 Outcome of acute severe ulcerative colitis in patients previously exposed to immunosoppressive therapy

S. Deiana*, S. Bagnoli, T. Gabbani, A.L. Inghilesi, N. Manetti, V. Annese

AOU Careggi, SOD Gastroenterologia 2, Firenze, Italy

Background

Overall mortality of ulcerative Colitis (UC) is comparable to that of general population, but the acute severe flare of UC (ASUC) remains a life-threatening condition. Intravenous steroid course still represents the standard treatment, while cyclosporine (cys) and infliximab (IFX) can be used with similar efficacy in case of failure. Since few data are available for patients with previous immunosuppressive (IMS) therapy, we aimed in this study to evaluate the outcome of ASUC in our referral centre, with particular attention paid to patients previously exposed to IMS drugs.

Methods

We retrospectively collected data from 86 ASUC cases (32 females and 54 males, mean age 44.1 yrs, mean duration of disease 6,5 yrs), according to Truelove and Witt's criteria, consecutively admitted to our Gastroenterology Unit from January 2008 to September 2014. According to ECCO's Guidelines all ASUC patients were treated with a short course of iv. steroid and in case of failure they were treated with a rescue therapy with Cys or IFX if colectomy was not deemed necessary by the surgeon. All statistical analyses were done by the SPSS software. A P value less than 0.05 was considered statistically significant.

Results

72 (83,7%) patients had an extensive colitis while only 8 (9,3%) were at first diagnosis. 39 patients were never treated with IMS (group A), while the remaining 47 had previous therapy, alone or in combination, with AZA (n=37), Cys (n=11) or IFX (n=27)(Group B). Patients of group B were significantly younger (40,9 yrs vs 47,9 yrs; p=0,05) and with a longer disease duration (8,5 yrs vs 4,8 yrs; p=0.02). 29 patients responded to steroids (33,7%), 15 underwent colectomy (17,4%) and 42 (48,8%) were switched to rescue therapy (14 Cys, 28 IFX), which failed in 4 patients requiring colectomy. The early (within 1 month) colectomy rate was 22,1, with a trend towards a lower response rate to steroids (25,5% vs 43,6%; p=0,10) and an higher need for colectomy (29,8% vs 12,8%; p=0,07), in group B compared to group A. During the follow-up period (19,5 months, range 1-72) further 10 patients underwent colectomy (5 for each group). The colectomy rate at the end of follow-up was 25.6% in Group A and 40.4% in group B (p=0.17)(33,7% in the entire cohort). The Kaplan Meyer probability to avoid surgery was 71,9% and 65,5% at 1 yrs and 71,9% and 55,4% at 2 yrs (p=0,30), for group A and B, respectively.

Conclusion

Patients with previous IMS therapy have a trend towards lower response to steroid treatment compared to IMS naïve patients, but the response rate to rescue therapy remains satisfactory, with similar need for colectomy.