Infliximab versus Cyclosporine Treatment for Severe Corticosteroid-Refractory Ulcerative Colitis: A Korean, Retrospective, Single Center Study
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Background/Aims: In patients with corticosteroid-refractory ulcerative colitis (UC), cyclosporine or infliximab may be added to the treatment regimen to induce remission. Here, we aimed to compare the efficacy of cyclosporine and infliximab. Methods: Between January 1995 and May 2012, the medical records of 43 patients with corticosteroid-refractory UC who received either infliximab or cyclosporine as a rescue therapy at a tertiary care hospital in Korea were reviewed. Results: Among the 43 patients, 10 underwent rescue therapy with cyclosporine and the remaining 33 patients received infliximab. A follow-up of 12 months was completed for all patients. The colectomy rate at 12 months was 30% and 3% in the cyclosporine and the infliximab groups, respectively (p=0.034). However, the Cox proportional hazard model indicated that the treatment of rescue therapy was not an independent associate factor for preventing colectomy (p=0.164). In the subgroup analysis, infliximab with azathioprine was superior to cyclosporine for preventing colectomy (hazard ratio of infliximab with azathioprine compared with cyclosporine only, 0.073; 95% confidence interval, 0.008 to 0.629). Conclusions: No difference between infliximab and cyclosporine with respect to preventing colectomy was noted. However, infliximab with azathioprine may be more effective than cyclosporine alone for preventing colectomy.
Abstract
Background/Aims: In patients with corticosteroid-refractory ulcerative colitis (UC), cyclosporine or infliximab may be added to the treatment regimen to induce remission. Here, we aimed to compare the efficacy of cyclosporine and infliximab. Methods: Between January 1995 and May 2012, the medical records of 43 patients with corticosteroid-refractory UC who received either infliximab or cyclosporine as a rescue therapy at a tertiary care hospital in Korea were reviewed. Results: Among the 43 patients, 10 underwent rescue therapy with cyclosporine and the remaining 33 patients received infliximab. A follow-up of 12 months was completed for all patients. The colectomy rate at 12 months was 30% and 3% in the cyclosporine and the infliximab groups, respectively (p=0.034). However, the Cox proportional hazard model indicated that the treatment of rescue therapy was not an independent associate factor for preventing colectomy (p=0.164). In the subgroup analysis, infliximab with azathioprine was superior to cyclosporine for preventing colectomy (hazard ratio of infliximab with azathioprine compared with cyclosporine only, 0.073; 95% confidence interval, 0.008 to 0.629). Conclusions: No difference between infliximab and cyclosporine with respect to preventing colectomy was noted. However, infliximab with azathioprine may be more effective than cyclosporine alone for preventing colectomy.
참고문헌 (35)
- Gracie DJ, "Evidence-based management of ulcerative colitis", Minerva Gastroenterol Dietol, 58, pp.87~99 (2012)
- Dean KE, "Infliximab or cyclosporine for acute severe ulcerative colitis: a retrospective analysis", J Gastroenterol Hepatol, 27, pp.487~492 (2012)
- Dinesen LC, "The pattern and outcome of acute severe colitis", J Crohns Colitis, 4, pp.431~437 (2010)
- Truelove SC, "Cortisone in ulcerative colitis: final report on a therapeutic trial", Br Med J, 2, pp.1041~1048 (1955)
- Truelove SC, "Intensive intravenous regimen for severe attacks of ulcerative colitis", Lancet, 1, pp.1067~1070 (1974)
- 김덕환, "Clinical Outcomes and Predictive Factors for Response after the First Course of Corticosteroid Therapy in Patients with Crohn’s Disease", Gut and Liver, 7(1), pp.58~65 (2013), 거트앤리버 발행위원회
- Gearry RB, "Rescue therapy for steroid refractory acute severe ulcerative colitis: more choice, better outcomes?", J Gastroenterol Hepatol, 27, pp.417~418 (2012)
- Kaur M, "Ulcerative colitis: steroid-refractory ulcerative colitis-ciclosporin or infliximab?", Nat Rev Gastroenterol Hepatol, 10, pp.8~9 (2013)
- Järnerot G, "Intensive intravenous treatment of ulcerative colitis", Gastroenterology, 89, pp.1005~1013 (1985)
- Lichtiger S, "Cyclosporine in severe ulcerative colitis refractory to steroid therapy", N Engl J Med, 330, pp.1841~1845 (1994)
- Levesque BG, "Infliximab versus ciclosporin in severe ulcerative colitis", Lancet, 380, pp.1887~1888 (2012)
- Rolny P, "Cyclosporine in patients with severe steroid refractory ulcerative colitis in the era of infliximab: review article", Scand J Gastroenterol, 48, pp.131~135 (2013)
- Singh S, "Management of severe steroid-refractory ulcerative colitis: cyclosporine or infliximab?", Gastroenterology, 144, pp.1138~1140 (2013)
- Arts J, "Long-term outcome of treatment with intravenous cyclosporin in patients with severe ulcerative colitis", Inflamm Bowel Dis, 10, pp.73~78 (2004)
- Rutgeerts P, "Infliximab for induction and maintenance therapy for ulcerative colitis", N Engl J Med, 353, pp.2462~2476 (2005)
- Järnerot G, "Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study", Gastroenterology, 128, pp.1805~1811 (2005)
- Laharie D, "Ciclosporin versus infliximab in patients with severe ulcerative colitis refractory to intravenous steroids: a parallel, open-label randomised controlled trial", Lancet, 380, pp.1909~1915 (2012)
- Lee KM, "Efficacy, safety, and predictors of response to infliximab therapy for ulcerative colitis: a Korean multicenter retrospective study", J Gastroenterol Hepatol, 28, pp.1829~1833 (2013)
- González-Altamirano J, "Advances in the diagnosis, pathophysiology and treatment of chronic non-specific ulcerative colitis", Rev Gastroenterol Mex, 78(1), pp.65~67 (2013)
- Mocciaro F, "Cyclosporine or infliximab as rescue therapy in severe refractory ulcerative colitis: early and long-term data from a retrospective observational study", J Crohns Colitis, 6, pp.681~686 (2012)
- 김은수, "Inflammatory Bowel Disease in Korea: Epidemiological, Genomic, Clinical, and Therapeutic Characteristics", Gut and Liver, 4(1), pp.1~14 (2010), 거트앤리버 발행위원회
- Lee JH, "The prevalence and clinical significance of perinuclear anti-neutrophil cytoplasmic antibody in Korean patients with ulcerative colitis", Dig Dis Sci, 55, pp.1406~1412 (2010)
- Lee JH, "Do patients with ulcerative colitis diagnosed at a young age have more severe disease activity than patients diagnosed when older?", Digestion, 81, pp.237~243 (2010)
- Lee HJ, "Long-term clinical outcomes and factors predictive of relapse after 5-aminosalicylate or sulfasalazine therapy in patients with mild-to-moderate ulcerative colitis", Hepatogastroenterology, 59, pp.1415~1420 (2012)
- 정고은, "스테로이드 저항 중증 궤양성 대장염 환자에서 스테로이드와 Cyclosporin A의 병합 투여와 스테로이드 단독 연장 투여의 치료 효과 비교", 대한소화기학회지, 48(4), pp.263~268 (2006), 대한소화기학회
- Cohen RD, "Intravenous cyclosporin in ulcerative colitis: a five-year experience", Am J Gastroenterol, 94, pp.1587~1592 (1999)
- Ogata H, "A randomised dose finding study of oral tacrolimus (FK506) therapy in refractory ulcerative colitis", Gut, 55, pp.1255~1262 (2006)
- Baumgart DC, "Tacrolimus is safe and effective in patients with severe steroid-refractory or steroid-dependent inflammatory bowel disease: a long-term follow-up", Am J Gastroenterol, 101, pp.1048~1056 (2006)
- Moskovitz DN, "Incidence of colectomy during long-term follow-up after cyclosporine-induced remission of severe ulcerative colitis", Clin Gastroenterol Hepatol, 4, pp.760~765 (2006)
- Sands BE, "Infliximab in the treatment of severe, steroid-refractory ulcerative colitis: a pilot study", Inflamm Bowel Dis, 7, pp.83~88 (2001)
- Travis S, "Predicting the need for colectomy in severe ulcerative colitis: a critical appraisal of clinical parameters and currently available biomarkers", Gut, 60, pp.3~9 (2011)
- Sandborn WJ, "Colectomy rate comparison after treatment of ulcerative colitis with placebo or infliximab", Gastroenterology, 137, pp.1250~1260 (2009)
- Farkas K, "Predictors of relapse in patients with ulcerative colitis in remission after one-year of infliximab therapy", Scand J Gastroenterol, 48, pp.1394~1398 (2013)
- Löwenberg M, "Treatment of patients with severe glucocorticoid-refractory ulcerative colitis: cyclosporine or infliximab?", Ned Tijdschr Geneeskd, 157, pp.A6130~ (2013)
- Croft A, "Outcomes of salvage therapy for steroid-refractory acute severe ulcerative colitis: ciclosporin vs. infliximab", Aliment Pharmacol Ther, 38, pp.294~302 (2013)