title: Tacrolimus or infliximab for severe ulcerative colitis: short-term and long-term data from a retrospective observational study.
abstract: OBJECTIVE
  Treatment of severe ulcerative colitis (UC) is challenging. Although the efficacy of tacrolimus (TAC) and infliximab (IFX) have been evaluated in patients with severe UC, the safety and efficacy levels of sequential therapies (TAC→IFX/IFX→TAC) in these patients remain unclear. The aim of this study was to assess short-term and long-term outcomes in patients with severe UC treated with TAC and IFX.
  
  
  METHODS
  From October 2001 to February 2014, 29 patients with consecutive severe UC treated with TAC or IFX were retrospectively evaluated. Median follow-up duration was 27 months (range 0.5-118 months). The primary end point was short-term outcomes at 8 weeks after induction of TAC (TAC group, n=22) or IFX (IFX group, n=7). The secondary end point included long-term outcomes and colectomy-free survival. The clinical response was evaluated based on a partial Mayo score.
  
  
  RESULTS
  The clinical remission (CR) rate at 8 weeks in the TAC and IFX groups was 63.6% and 71.4%, respectively. In 13 of the 29 patients (10 in the TAC group, 3 in the IFX group), sequential therapies were used in their clinical courses. In 9 of these 13 patients (6 in the TAC group, 3 in the IFX group), CR was achieved and maintained by sequential therapies. Overall cumulative colectomy-free survival was 79.3% at 118 months.
  
  
  CONCLUSIONS
  TAC and IFX had similar effects on remission induction in patients with severely active UC. Sequential therapies could rescue patients with UC who failed initial treatment with TAC or IFX. In clinical practice, sequential therapies might be deliberately performed.
authors.affiliation: Department of Gastroenterology and Hepatology , Graduate School of Medicine, Kyoto University , Kyoto , Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Minami
authors.affiliation: Department of Gastroenterology and Hepatology , Graduate School of Medicine, Kyoto University , Kyoto , Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Yoshino
authors.affiliation: Department of Gastroenterology and Hepatology , Graduate School of Medicine, Kyoto University , Kyoto , Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Matsuura
authors.affiliation: Department of Gastroenterology and Hepatology , Graduate School of Medicine, Kyoto University , Kyoto , Japan.
authors.forename: Yorimitsu
authors.initials: Y
authors.lastname: Koshikawa
authors.affiliation: Department of Gastroenterology and Hepatology , Graduate School of Medicine, Kyoto University , Kyoto , Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamada
authors.affiliation: The Third Department of Internal Medicine , Kansai Medical University , Hirakata , Japan.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Toyonaga
authors.affiliation: Department of Internal Medicine, Faculty of Medicine , Al-Azhar University , Cairo , Egypt.
authors.forename: Ali
authors.initials: A
authors.lastname: Madian
authors.affiliation: Department of Gastroenterology and Hepatology , Graduate School of Medicine, Kyoto University , Kyoto , Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Honzawa
authors.affiliation: Department of Gastroenterology and Hepatology , Graduate School of Medicine, Kyoto University , Kyoto , Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakase
keywords: IBD CLINICAL; INFLAMMATORY BOWEL DISEASE; ULCERATIVE COLITIS