title: The effectiveness and safety of rescue treatments in 108 patients with steroid-refractory ulcerative colitis with sequential rescue therapies in a subgroup of patients.
abstract: BACKGROUND
  Among patients with steroid-refractory ulcerative colitis (UC) in whom a first rescue therapy has failed, a second line salvage treatment can be considered to avoid colectomy.
  
  
  OBJECTIVE
  To evaluate the efficacy and safety of second or third line rescue therapy over a one-year period.
  
  
  METHODS
  Response to single or sequential rescue treatments with infliximab (5mg/kg intravenously (iv) at week 0, 2, 6 and then every 8weeks), ciclosporin (iv 2mg/kg/daily and then oral 5mg/kg/daily) or tacrolimus (0.05mg/kg divided in 2 doses) in steroid-refractory moderate to severe UC patients from 7 Swiss and 1 Serbian tertiary IBD centers was retrospectively studied. The primary endpoint was the one year colectomy rate.
  
  
  RESULTS
  60% of patients responded to the first rescue therapy, 10% went to colectomy and 30% non-responders were switched to a 2(nd) line rescue treatment. 66% of patients responded to the 2(nd) line treatment whereas 34% failed, of which 15% went to colectomy and 19% received a 3(rd) line rescue treatment. Among those, 50% patients went to colectomy. Overall colectomy rate of the whole cohort was 18%. Steroid-free remission rate was 39%. The adverse event rates were 33%, 37.5% and 30% for the first, second and third line treatment respectively.
  
  
  CONCLUSIONS
  Our data show that medical intervention even with 2(nd) and 3(rd) rescue treatments decreased colectomy frequency within one year of follow up. A longer follow-up will be necessary to investigate whether sequential therapy will only postpone colectomy and what percentage of patients will remain in long-term remission.
authors.affiliation: Department of Gastroenterology, Spital Tiefenau, Tiefenaustrasse 112, 3004 Bern, Switzerland; Division of Clinical Pharmacology and Toxicology, University Hospital Zürich, Zürich, Switzerland. Electronic address: marijana.n.protic@gmail.com.
authors.forename: Marijana
authors.initials: M
authors.lastname: Protic
authors.affiliation: Department of Gastroenterology, Spital Tiefenau, Tiefenaustrasse 112, 3004 Bern, Switzerland; Department of Gastroenterology, Inselspital, University Hospital Bern, Switzerland. Electronic address: Frank.Seibold@spitalnetzbern.ch.
authors.forename: Frank
authors.initials: F
authors.lastname: Seibold
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital Lausanne, Lausanne, Switzerland. Electronic address: alain.schoepfer@chuv.ch.
authors.forename: Alain
authors.initials: A
authors.lastname: Schoepfer
authors.affiliation: Department of Statistics, Faculty of Organizational Sciences, Belgrade, Serbia. Electronic address: zoran@fon.rs.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Radojicic
authors.affiliation: Department of Gastroenterology, Inselspital, University Hospital Bern, Switzerland. Electronic address: pascal.juillerat@insel.ch.
authors.forename: Pascal
authors.initials: P
authors.lastname: Juillerat
authors.affiliation: Department of Gastroenterology, University Hospital Zvezdara, Belgrade, Serbia. Electronic address: 8411112@telenormail.rs.
authors.forename: Daniela
authors.initials: D
authors.lastname: Bojic
authors.affiliation: Division of Clinical Pharmacology and Toxicology, University Hospital Zürich, Zürich, Switzerland. Electronic address: jessica.mwinyi@usz.ch.
authors.forename: Jessica
authors.initials: J
authors.lastname: Mwinyi
authors.affiliation: Department of Gastroenterology, Hospital Neuchâtel, Neuchâtel, Switzerland. Electronic address: christian.mottet@h-ne.ch.
authors.forename: Christian
authors.initials: C
authors.lastname: Mottet
authors.affiliation: Department of Gastroenterology, University Hospital Zvezdara, Belgrade, Serbia. Electronic address: ibd@eunet.rs.
authors.forename: Njegica
authors.initials: N
authors.lastname: Jojic
authors.affiliation: Department of Gastroenterology, University Hospital Basel, Basel, Switzerland. Electronic address: beglinger@tmr.ch.
authors.forename: Christoph
authors.initials: C
authors.lastname: Beglinger
authors.affiliation: Department of Gastroenterology and Hepatology, Stadtspital Triemli, Zürich, Switzerland. Electronic address: stephan.vavricka@triemli.stzh.ch.
authors.forename: Stephan
authors.initials: S
authors.lastname: Vavricka
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland. Electronic address: gerhard.rogler@usz.ch.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Rogler
authors.affiliation: Department of Gastroenterology, See Spital, Horgen, Switzerland. Electronic address: pascal.frei@see-spital.ch.
authors.forename: Pascal
authors.initials: P
authors.lastname: Frei
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D003082:Colectomy / Q000009:adverse effects; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000009:adverse effects; D012720:Severity of Illness Index; D013256:Steroids / Q000627:therapeutic use; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use*; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine; D000069285:Infliximab; D016559:Tacrolimus
keywords: Ciclosporin; Inflammatory bowel disease; Infliximab; Tacrolimus; Ulcerative colitis