Use of corticosteroids, immunomodulators, and infliximab at a third-level Day-Hospital Service of Gastro-Hepatology.
OBJECTIVE
Third-level Day-Hospital Services of Gastro-Hepatology are likely to recruit patients with an increased disease severity. The burden of request for immunomodulation drugs is presently unclear.


METHODS
The charts of 1 012 consecutive patients who underwent day-hospital admission were reviewed. Among them, 975 were admitted for several reasons (percutaneous liver biopsies, abdominal fluid aspirations, infiltrations of hepatic nodules, gastrointestinal endoscopies with specific treatments). Data of the remaining 37 patients were elaborated.


RESULTS
Of them, 31 (83%) suffered from ulcerative colitis (UC) or Crohn's disease (CD) (17 and 14, respectively) and 6 from autoimmune type 1 hepatitis (AIH). Of the 14 non-operated UC patients, 12 were taking azathioprine (AZA) and 2 infliximab (IFX). Among CD patients, the majority received AZA (N=6) or IFX (N=6). Of the AIH patients, 5 were treated with AZA and 2 had also cyclosporine. Overall, corticosteroids (32%) and IFX (21%) ranked first and second among the induction drugs, and AZA ranked first (62%) as maintenance option. Of the 4 CD patients under IFX treatment, 2 were switched to leukapheresis for incomplete response, the third one developed thrombotic complications, and the last one achieved disease remission after 12 months. Of the 2 cases of UC, one lost response soon and was colectomized, the other is maintaining moderately active disease, requiring scheduled injections every 8 weeks.


CONCLUSIONS
Despite the caution imposed by the very small numbers, this analysis confirms that the potent available options are difficult to be correctly positioned in the therapeutic algorithm of inflammatory bowel disease.
Actis
G C
GC
Department of Gastro-Hepatology, Molinette Hospital, Turin, Italy. actis_g@libero.it
Pellicano
R
R
Bugianesi
E
E
Lagget
M
M
Rizzetto
M
M
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy; D003424:Crohn Disease / Q000188:drug therapy; D003631:Day Care, Medical; D004359:Drug Therapy, Combination; D005260:Female; D005767:Gastrointestinal Diseases / Q000188:drug therapy*; D005938:Glucocorticoids / Q000627:therapeutic use*; D019693:Hepatitis, Autoimmune / Q000188:drug therapy; D006784:Hospitals, Teaching; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D000069285:Infliximab; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D005938:Glucocorticoids; D007155:Immunologic Factors; D000069285:Infliximab