The effectiveness and safety of rescue treatments in 108 patients with steroid-refractory ulcerative colitis with sequential rescue therapies in a subgroup of patients

Abstract

Background: Among patients with steroid-refractory ulcerative colitis (UC) in whom a first rescue therapy has failed, a second line salvage treatment can be considered to avoid colectomy. Aim: To evaluate the efficacy and safety of second or third line rescue therapy over a one-year period. Methods: Response to single or sequential rescue treatments with infliximab (5 mg/kg intravenously (iv) at week 0, 2, 6 and then every 8 weeks), ciclosporin (iv 2 mg/kg/daily and then oral 5 mg/kg/daily) or tacrolimus (0.05 mg/kg divided in 2 doses) in steroid-refractory moderate to severe UC patients from 7 Swiss and 1 Serbian tertiary IBD centers was retrospectively studied. The primary endpoint was the one year colectorny rate. Results: 60% of patients responded to the first rescue therapy, 10% went to colectomy and 30% non-responders were switched to a 2nd line rescue treatment. 66% of patients responded to the 2nd line treatment whereas 34% failed, of which 15% went to colectomy and 19% received a 3rd line rescue treatment. Among those, 50% patients went to colectomy. Overall colectomy rate of the whole cohort was 18%. 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. Conclusion: Our data show that medical intervention even with 2nd and 3rd rescue treatments decreased colectomy frequency within one year of follow up. A longer follow-up will be necessary to investigate whether sequential therapy will only postpone colectomy and what percentage of patients will remain in long-term remission.