title: Improved outcome of acute severe ulcerative colitis while using early predictors of corticosteroid failure and rescue therapies.
abstract: OBJECTIVE
  Intravenous corticosteroids remain the first line therapy for severe attacks of ulcerative colitis although up to 30-40% of patients do not respond to treatment. The availability of alternative therapies to colectomy and the knowledge of early predictors of response to corticosteroids should have improved the clinical outcomes of patients with severe refractory ulcerative colitis. The aim of the study is to describe the current need, way of use, and efficacy of rescue therapies, as well as colectomy rates in patients with severe ulcerative colitis flares.
  
  
  METHODS
  Between January 2005 and December 2011, all patients admitted in three referral centres for a severe ulcerative colitis flare who received intravenous corticosteroids were identified and clinical and biological data were accurately collected. Patients were followed-up until colectomy, death, or date of data collection.
  
  
  RESULTS
  Sixty-two flares were included. Initial efficacy of intravenous corticosteroids (mild activity or inactive disease without rescue treatment, at day 7 after starting intravenous corticosteroids) was achieved in 50% of flares, and rescue therapies were used in 27 episodes (43%). After a median follow-up of 18 months, the colectomy rate was 6.5%. Failed oral corticosteroids for the index flare were the only baseline feature that predicted the need for rescue therapy and colectomy.
  
  
  CONCLUSIONS
  There is a marked reduction in the colectomy rate and an increased use of medical rescue therapies as compared to historical series. Patients worsening while on oral corticosteroids for a moderate flare are at high risk of rescue therapy and colectomy and, therefore, should be directly treated with rescue therapies instead of attempting intravenous corticosteroids.
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Jordina
authors.initials: J
authors.lastname: Llaó
authors.affiliation: Hospital Universitari Germans Trias i Pujol, Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas, Badalona, Spain.
authors.forename: Juan E
authors.initials: JE
authors.lastname: Naves
authors.affiliation: Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Spain.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Ruiz-Cerulla
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Gordillo
authors.affiliation: Hospital Universitari Germans Trias i Pujol, Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas, Badalona, Spain.
authors.forename: Míriam
authors.initials: M
authors.lastname: Mañosa
authors.affiliation: Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Spain.
authors.forename: Sandra
authors.initials: S
authors.lastname: Maisterra
authors.affiliation: Hospital Universitari Germans Trias i Pujol, Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas, Badalona, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Cabré
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Garcia-Planella
authors.affiliation: Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Guardiola
authors.affiliation: Hospital Universitari Germans Trias i Pujol, Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas, Badalona, Spain. Electronic address: eugenidomenech@gmail.com.
authors.forename: Eugeni
authors.initials: E
authors.lastname: Domènech
mesh_terms: D061605:Administration, Intravenous; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000628:therapy*; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000069285:Infliximab / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013030:Spain; D062606:Tertiary Care Centers; D017211:Treatment Failure
chemical_list: D000305:Adrenal Cortex Hormones; D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000069285:Infliximab
keywords: Colectomy; Corticosteroids; Cyclosporine; Infliximab; Ulcerative colitis