title: Infliximab or cyclosporine as rescue therapy in hospitalized patients with steroid-refractory ulcerative colitis: a retrospective observational study.
abstract: BACKGROUND
  Cyclosporine (CsA) or infliximab (IFX) are used as rescue therapies in steroid-refractory, severe attacks of ulcerative colitis (UC). There are no data comparing the efficacy of these two alternatives.
  
  
  METHODS
  Outcome of rescue therapy was retrospectively studied in two cohorts of patients hospitalized due to steroid-refractory moderate to severe UC: 1) a Swedish-Danish cohort (n = 49) treated with a single infusion of IFX; 2) an Austrian cohort (n = 43) treated with intravenous CsA. After successful rescue therapy, maintenance immunomodulator treatment was given to 27/33 (82%) of IFX patients and to 31/40 (78%) of CsA patients. Endpoints were colectomy-free survival at 3 and 12 months. Kaplan-Meier and Cox regression models were used to evaluate the association between treatment groups and colectomy.
  
  
  RESULTS
  At 15 days, colectomy-free survival in the IFX cohort was 36/49 (73%) versus 41/43 (95%) in the CsA cohort (P = 0.005), at 3 months 33/49 (67%) versus 40/43 (93%) (P = 0.002), and at 12 months 28/49 (57%) versus 33/43 (77%) (P = 0.034). After adjusting for potential confounding factors, Cox regression analysis yielded adjusted hazard ratios for risk of colectomy in IFX-treated patients of 11.2 (95% confidence interval [CI] 2.4-53.1, P = 0.002) at 3 months and of 3.0 (95% CI 1.1-8.2, P = 0.030) at 12 months in comparison with CsA-treated patients. There were no opportunistic infections or mortality.
  
  
  CONCLUSIONS
  Colectomy frequencies were significantly lower after rescue therapy with CsA than with a single infusion of IFX both at 3 and 12 months' follow-up. The superiority of CsA was seen principally during the first 15 days.
authors: Department of Medicine, Skaraborgs hospital, Lidköping, Sweden.
authors: Mats
authors: M
authors: Sjöberg
authors: Andrea
authors: A
authors: Walch
authors: Mina
authors: M
authors: Meshkat
authors: Anders
authors: A
authors: Gustavsson
authors: Gunnar
authors: G
authors: Järnerot
authors: Harald
authors: H
authors: Vogelsang
authors: Erik
authors: E
authors: Hertervig
authors: Gottfried
authors: G
authors: Novacek
authors: Ingalill
authors: I
authors: Friis-Liby
authors: Lars
authors: L
authors: Blomquist
authors: Sieglinde
authors: S
authors: Angelberger
authors: Per
authors: P
authors: Karlen
authors: Christer
authors: C
authors: Grännö
authors: Mogens
authors: M
authors: Vilien
authors: Magnus
authors: M
authors: Ström
authors: Hans
authors: H
authors: Verbaan
authors: Per M
authors: PM
authors: Hellström
authors: Clemens
authors: C
authors: Dejaco
authors: Anders
authors: A
authors: Magnuson
authors: Jonas
authors: J
authors: Halfvarson
authors: Walter
authors: W
authors: Reinisch
authors: Curt
authors: C
authors: Tysk
mesh_terms: D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D016572:Cyclosporine; D000069285:Infliximab