Background: Corticosteroids remain the treatment of choice for patients with moderate and severe UC. Cyclosporine (CsA) and infliximab (IFX) are effective rescue agents for patients refractory to IV steroids, with similar short-term outcomes between the two. Traditionally, there has been reluctance to use CsA due to an increased risk of long-term colectomy (50% at 5 years); however, this situation may have changed since the advent of infliximab. Our hypothesis is that nowadays salvage therapy with biologics can improve long-term colectomy rates in patients with UC who are treated with CsA, and thus, that CsA may still be considered an effective treatment option for these patients
Aim: To assess the long-term outcome and colectomy rate of patients with moderate-to-severe UC who initially respond to CsA
Methods: This is a multicenter retrospective cohort study including patients with moderate-to-severe corticorrefractory UC and early response to CsA. Exclusion criteria were: colectomy requirement, rescue therapy with a biologic agent within the first 3 months after CsA treatment, and contrainidication for the use of IFX. We defined two cohorts: 1) the first cohort (C1) included patients with UC who were treated before the advent of biologics, between the years 1995 and 2000; and 2) the second cohort (C2) comprised patients with UC treated between 2005 and 2010, after IFX became available.
Results: A total of 192 patients were included (56 in C1 and 136 in C2). Median age was 38 years, 99 (51,6%) patients were male, 149 (77.6%) had extensive colitis, 104 (54.2%) were non-smokers, mean disease duration was 47 months and 38 (19.8%) had been treated previously with thiopurines. Mean CsA duration was 107 days and after CsA withdrawal, 173 (90.1%) patients received maintenance treatment with thiopurines. During follow-up, 89 (46.4%) patients received steroids and 61 (31.8%) required an admission. In C2, 38 (27.9%) patients were treated with IFX within the 5 years. The global colectomy rate were 16.14% at 5 years. Colectomy rates in C1 were 10.7%, 17.6%, 25% and 26.8% at 12, 24, 36 and 60 months respectively. Colectomy rate was lower in C2 (5.1%, 9.6%, 11% and 11,8% at 12, 24, 36 and 60 months respectively), (p=0.01). Predictors of colectomy in the multivariate analysis were previous treatment with thiopurines (OR 2.9 (95% CI: 1.2–6.7)) and patients of the first cohort (C1) OR 2.7 (95% CI: 1.3–6).
Conclusions: The long-term outcome of UC patients treated with CsA has been improved in the biological era. CsA may be considered in UC patients who are refractory to intravenous steroids and naive to thiopurines