Severe ulcerative colitis: predictors of response and algorithm proposal for rescue therapy

Area of Science:

• Gastroenterology
• Immunology
• Pharmacology

Background:

• Severe steroid-refractory ulcerative colitis (UC) treatment efficacy is debated.
• Predicting response to rescue therapies like infliximab and cyclosporine A is crucial for patient management.

Purpose of the Study:

• To identify predictors of treatment response to infliximab and cyclosporine A in severe UC.
• To guide therapeutic decisions for patients with severe UC.

Main Methods:

• Cross-sectional study including 49 patients with severe UC.
• Response defined as >=3 point reduction in Mayo score after 6 months and colectomy avoidance after 1 year.
• Analyzed predictors: gender, age, disease duration, prior steroid/azathioprine use, smoking, disease extent, labs, and Mayo score.

Main Results:

• Infliximab responders had moderate Mayo scores (P=0.04); ex-smokers showed low response (P=0.03).
• Cyclosporine A responders had C-reactive protein (CRP) >3 mg/L (P=0.03).
• Elevated CRP and/or severe Mayo score predicted better cyclosporine A response (15 vs 4, P=0.008).

Conclusions:

• Cyclosporine A is suggested for ex-smokers.
• For never/active smokers, infliximab is recommended for Mayo score <=10 and/or negative CRP.
• Cyclosporine A is indicated for Mayo score >10 and positive CRP in smokers.