title: Long-term comparative efficacy of cyclosporine- or infliximab-based strategies for the management of steroid-refractory ulcerative colitis attacks.
abstract: BACKGROUND
  The short-term efficacy of infliximab (IFX) and cyclosporine A (CsA) in steroid-refractory ulcerative colitis (SRUC) has been recently shown to be similar, but long-term outcomes are still unclear. Moreover, the need for further rescue therapies in patients treated with IFX or CsA for SRUC has not been reported. The aims of our study were to compare short-term and long-term efficacy between 2 different strategies based on initial treatment with CsA or IFX for SRUC attacks.
  
  
  METHODS
  Between January 2005 and December 2011, all patients admitted for SRUC who required medical rescue therapy were identified from the electronic databases of 3 referral centers and grouped according to whether they received CsA or IFX as first-line rescue therapy, and retrospectively reviewed.
  
  
  RESULTS
  Among 50 SRUC attacks, 20 were treated with CsA as first-line rescue therapy and 30 with IFX. The CsA group had a higher proportion of patients with severe UC activity immediately before rescue therapy (P = 0.03) and a shorter median time from intravenous corticosteroids to rescue therapy (P = 0.03). A higher proportion of patients in the CsA group received second-line drug therapy (switch) as compared with the IFX group (P = 0.04). Fifteen patients (30%) were colectomized during the study period, with no between-group differences. Previous thiopurine exposure (P = 0.004; odds ratio = 6.1 [1.7-20.9]) was the only independent predictor of colectomy.
  
  
  CONCLUSIONS
  CsA- and IFX-based strategies for SRUC seem similarly effective in preventing colectomy in the short and long term, although second-line drug therapy is more often required with CsA-based strategies.
authors.affiliation: *Hospital Universitari Germans Trias i Pujol and Ciberehd, Badalona, Spain; †Universitat Autònoma de Barcelona, Barcelona, Spain; ‡Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; and §Hospital Universitari de Bellvitge and IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Juan E
authors.initials: JE
authors.lastname: Naves
authors.forename: Jordina
authors.initials: J
authors.lastname: Llaó
authors.forename: Alexandra
authors.initials: A
authors.lastname: Ruiz-Cerulla
authors.forename: Cristina
authors.initials: C
authors.lastname: Romero
authors.forename: Míriam
authors.initials: M
authors.lastname: Mañosa
authors.forename: Triana
authors.initials: T
authors.lastname: Lobatón
authors.forename: Eduard
authors.initials: E
authors.lastname: Cabré
authors.forename: Esther
authors.initials: E
authors.lastname: Garcia-Planella
authors.forename: Jordi
authors.initials: J
authors.lastname: Guardiola
authors.forename: Eugeni
authors.initials: E
authors.lastname: Domènech
mesh_terms: D000305:Adrenal Cortex Hormones / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D016572:Cyclosporine / Q000627:therapeutic use*; D019468:Disease Management; D019008:Drug Resistance, Neoplasm / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D011379:Prognosis
chemical_list: D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000069285:Infliximab