title: Long-term outcome of ulcerative colitis in patients who achieve clinical remission with a first course of corticosteroids.
abstract: BACKGROUND
  Although the early outcomes of ulcerative colitis after a first course of corticosteroids are well known, data on long-term disease evolution in patients responding to a first corticosteroid course are scarce.
  
  
  OBJECTIVE
  To evaluate the long-term clinical evolution in ulcerative colitis patients responding to a first course of corticosteroids and to identify those factors associated with a poorer outcome.
  
  
  METHODS
  Retrospective review of 114 patients diagnosed with ulcerative colitis who responded to the first corticosteroid course, and did not start thereafter maintenance therapy with thiopurines were included.
  
  
  RESULTS
  Corticosteroids were prescribed because of a moderate (78%) or a severe flare (22%). All but two patients followed maintenance treatment with mesalazine after corticosteroid discontinuation. After a median follow-up of 83 months (7-156), 72% of patients suffered new relapses leading to corticosteroid reintroduction in 65% of patients. The earlier corticosteroids were introduced in the course of ulcerative colitis, the higher the risk of relapse and corticosteroid reintroduction. Thiopurines were started in 51%, and infliximab in 19%. Eleven percent of patients underwent colectomy. No predictors of thiopurine use or colectomy were found.
  
  
  CONCLUSIONS
  Half of the ulcerative colitis patients responding to a first course of corticosteroids will require immunosuppressors mainly because of steroid-dependence.
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Garcia-Planella
authors.forename: Míriam
authors.initials: M
authors.lastname: Mañosa
authors.forename: Manuel
authors.initials: M
authors.lastname: Van Domselaar
authors.forename: Jordi
authors.initials: J
authors.lastname: Gordillo
authors.forename: Yamile
authors.initials: Y
authors.lastname: Zabana
authors.forename: Eduard
authors.initials: E
authors.lastname: Cabré
authors.forename: Antonio
authors.initials: A
authors.lastname: López San Román
authors.forename: Eugeni
authors.initials: E
authors.lastname: Domènech
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab; D053208:Kaplan-Meier Estimate; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D019804:Mesalamine; D000069285:Infliximab