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News

Outcomes of rescue therapy in acute severe ulcerative colitis

This month's issue of the Alimentary Pharmacology & Therapeutics reports data from the United Kingdom inflammatory bowel disease audit on rescue therapy in ulcerative colitis.

News image

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."

Aliment Pharmacol Ther 2013: 38(8): 935–945
03 October 2013

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