Approximately one third of patients with acute severe ulcerative colitis (ASUC) fail response to steroids.
Ciclosporin and anti-TNFα are proven second-line therapies, but evidence of their efficacy has come mainly from tertiary centers and/or selective clinical trial recruitment.
Dr Lynch and colleagues from the United Kingdom assessed acute severe ulcerative colitis outcomes in a large unselected cohort.
UK-wide audits of IBD care were conducted in 2008 and 2010, covering more than 87% of admitting hospitals.
Each site entered data from 20 consecutive ulcerative colitis admissions onto a web-based proforma.
|Response to first-line steroid therapy was 58% in 2010|
|Alimentary Pharmacology & Therapeutics|
Admissions included 852 (2008) and 984 (2010) with acute severe ulcerative colitis, accounting for 35% and 39% of ulcerative colitis admissions, respectively.
The researchers found that acute severe ulcerative colitis in-hospital mortality was 1.2% in 2008, 0.7% in 2010.
Response to first-line steroid therapy was 61% in 2008, 58% in 2010.
The team noted that mortality was higher in non-responders.
In 2010, 56% of patients received second-line medical therapy than in 2008.
The researchers observed that in-hospital mortality was similar to second-line medical therapy vs. surgery without further medical therapy.
Second-line therapy response was more frequently observed with anti-TNFα than ciclosporin.
Dr Lynch's team commented, "Mortality in acute severe ulcerative colitis was low, but higher in steroid non-responders."
"Patients treated with second-line medical therapies had no higher risk of in-hospital mortality than those undergoing surgery."
"Second-line ‘rescue’ medical therapy usage is increasing; however, ciclosporin response rates were relatively low."