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Ulcerative colitis

Rescue immune suppression for severe colitis—worth the risk?

Up to 30% of patients with refractory ulcerative colitis have steroid-resistant disease and, if cured with restorative proctocolectomy, could develop pouchitis. Ciclosporin and infliximab monotherapy have been used experimentally to tackle this problem. A recent study has assessed ciclosporin and infliximab as second-line therapies when one has failed.

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References

  1. Leblanc, S. et al. Successive treatment with cyclosporine and infliximab in steroid-refractory ulcerative colitis. Am. J. Gastroenterol. 106, 771–777 (2011).

    Article  CAS  PubMed  Google Scholar 

  2. Faubion, W. A. Jr, Loftus, E. V. Jr, Harmsen, W. S., Zinsmeister, A. R. & Sandborn, W. J. The natural history of corticosteroid therapy for inflammatory bowel disease: a population-based study. Gastroenterology 121, 255–260 (2001).

    Article  CAS  PubMed  Google Scholar 

  3. Hueting, W. E., Buskens, E., van der Tweel, I., Gooszen, H. G. & van Laarhoven, C. J. Results and complications after ileal pouch anal anastomosis: a meta-analysis of 43 observational studies comprising 9,317 patients. Dig. Surg. 22, 69–79 (2005).

    Article  PubMed  Google Scholar 

  4. Actis, G. C., Fadda, M., David, E. & Sapino, A. Colectomy rate in steroid-refractory colitis initially responsive to cyclosporine: a long-term retrospective cohort study. BMC Gastroenterol. 7, 13 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  5. Arts, J. et al. Long-term outcome of treatment with intravenous cyclosporine in patients with severe ulcerative colitis. Inflamm. Bowel Dis. 10, 73–78 (2004).

    Article  PubMed  Google Scholar 

  6. Gustavsson, A. et al. Clinical trial: colectomy after rescue therapy in ulcerative colitis—3-year follow-up of the Swedish-Danish controlled infliximab study. Aliment. Pharmacol. Ther. 32, 984–989 (2010).

    Article  CAS  PubMed  Google Scholar 

  7. Lichtenstein, G. R. et al. Serious infections and mortality in association with therapies for Crohn's disease: TREAT registry. Clin. Gastroenterol. Hepatol. 4, 621–630 (2006).

    Article  CAS  PubMed  Google Scholar 

  8. Cheifetz, A. S. et al. Cyclosporine is safe and effective in patients with severe ulcerative colitis. J. Clin. Gastroenterol. 45, 107–112 (2011).

    Article  CAS  PubMed  Google Scholar 

  9. Laharie, D. et al. Cyclosporin versus infliximab in acute severe ulcerative colitis refractory to intravenous steroids: a randomized study. J. Crohns Colitis 5, S8 (2011).

    Google Scholar 

  10. Maser, E. A. et al. Cyclosporine and infliximab as rescue therapy for each other in patients with steroid-refractory ulcerative colitis. Clin. Gastroenterol. Hepatol. 6, 1112–1116 (2008).

    Article  CAS  PubMed  Google Scholar 

  11. Arijs, I. et al. Mucosal gene signatures to predict response to infliximab in patients with ulcerative colitis. Gut 58, 1612–1619 (2009).

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Giovanni C. Actis.

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Competing interests

M. Daperno has been a speaker and consultant for Abbott Laboratories and Merck-MSD. He has been a speaker for Chiesi Farmaceutica, Giuliani, Ferring and Sofar Farma. G. C. Actis declares no competing interests.

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Actis, G., Daperno, M. Rescue immune suppression for severe colitis—worth the risk?. Nat Rev Gastroenterol Hepatol 8, 303–304 (2011). https://doi.org/10.1038/nrgastro.2011.86

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