Ability of different rescue therapies to save the bowel in acute, severe, steroid-refractory ulcerative colitis

Abstract

To date, corticosteroids have been the primary therapies for acute, severe ulcerative colitis (UC). Patients not responding to intravenous steroids assessed at 3–5 days of the treatment are candidates for second-line rescue therapy. Cyclosporine (CsA), tacrolimus and infliximab (IFX) are also effective therapeutic options in acute, severe UC. In this review we summarized the results of the published studies examining and comparing the efficacy of CsA, tacrolimus and IFX as rescue therapies, and assessing the outcome of switching the drugs in case of therapeutic failure.

Keywords::

• acute ulcerative colitis
• cyclosporine
• infliximab
• rescue therapy
• tacrolimus

Financial & competing interests disclosure

This work was supported by OTKA Research Proposal PD 105948 (PI: Klaudia Farkas) and TÁMOP-4.2.2.A-11/1/KONV-2012-0035, TÁMOP-4.2.2-A-11/1/KONV-2012 0052 and TÁMOP-4.2.2.A-11/1/KONV-2012-0073. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Approximately 15% of patients with ulcerative colitis (UC) will have a severe acute attack requiring admission to hospital.

• Patients who do not respond within 3 days to intensive corticosteroid therapy should be considered for second-line rescue medical therapy or surgery.

• Cyclosporine and infliximab are effective rescue therapies.

• Tacrolimus was also shown to be effective in refractory UC, although there is not enough data supporting its use as rescue therapy.

• In patients with acute severe UC, therapeutic decision should be individualized.

• It is very important to know the demographic and clinical parameters, previous therapies, their duration and efficacies and side effects before a new therapy is introduced.

• Identifying biomarkers as predictors would be helpful to find the most appropriate and individual therapy for patients.

• The goal of medical therapy is to avoid colectomy while preventing complications of the disease, side effects of medications and mortality.

• However, surgery needs to be considered in time if there are no signs of improvement.