title: Outcome of acute severe ulcerative colitis in patients previously exposed to immunosuppressive therapy.
abstract: OBJECTIVE
  We aimed to evaluate the outcome of patients with acute severe ulcerative colitis previously exposed to immunosuppressive (IMS) therapy.
  
  
  METHODS
  We retrospectively collected data from 86 consecutive patients from 2008. Early outcome was evaluated as response to steroids, rescue therapy, and colectomy rate, whereas colectomy free-survival was determined along the follow-up.
  
  
  RESULTS
  The overall response rates to steroids and rescue therapy was 33.7% and 90.5%, respectively, while early colectomy rate was 22.1%. Patients previously treated with IMS (n=47) showed a trend towards lower response to steroids (25.5% vs 43.6%; p=0.10), and a high-risk of early colectomy (29.8% vs 12.8%; p=0.07), but a similar response to rescue therapy (87.5% vs 94.4%, p=0.62) when compared with IMS-naïve patients (n=39). The overall cumulative probability to avoid the surgery was 67.5% and 56.6% at 12 and 60 months, respectively, regardless of previous exposure to IMS (p=0.30). At multivariate analysis the risk of early colectomy was increased by previous IMS (OR 5.16, p=0.017), anaemia (OR 4.26, p=0.02), and diagnosis above 40 years (OR 5.31, p=0.011).
  
  
  CONCLUSIONS
  Patients previously treated with IMS showed a non-significant trend towards a worse response with steroid therapy, a satisfactory response rate to rescue therapy, and a similar probability of avoiding colectomy during the follow-up vs IMS-naive patients.
authors.affiliation: Department of Emergency, Division of Gastroenterology, AOU Careggi, Florence, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Deiana
authors.affiliation: Department of Emergency, Division of Gastroenterology, AOU Careggi, Florence, Italy.
authors.forename: Siro
authors.initials: S
authors.lastname: Bagnoli
authors.affiliation: Department of Emergency, Division of Gastroenterology, AOU Careggi, Florence, Italy.
authors.forename: Natalia
authors.initials: N
authors.lastname: Manetti
authors.affiliation: Unit of Molecular and Nutritional Epidemiology, Cancer Research and Prevention Institute (ISPO), Florence, Italy.
authors.forename: Saverio
authors.initials: S
authors.lastname: Caini
authors.affiliation: IBD Regional Referral Center, AOU Careggi, Florence, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Giannotta
authors.affiliation: Digestive Surgery Unit, Department of Surgery and Translational Medicine, University of Florence, AOU Careggi, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Scaringi
authors.affiliation: Department of Emergency, Division of Gastroenterology, AOU Careggi, Florence, Italy. Electronic address: annesev@aou-careggi.toscana.it.
authors.forename: Vito
authors.initials: V
authors.lastname: Annese
mesh_terms: D000208:Acute Disease; D000328:Adult; D003082:Colectomy / Q000706:statistics & numerical data*; D003093:Colitis, Ulcerative / Q000628:therapy*; D016572:Cyclosporine / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; 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; D015999:Multivariate Analysis; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine; D000069285:Infliximab
keywords: Acute severe ulcerative colitis; Colectomy rate; Cyclosporine; Immunosuppressive drugs; Infliximab