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Evolution of endoscopic lesions in steroid-refractory acute severe ulcerative colitis responding to infliximab or cyclosporine

D. Laharie 1, 2 A. Bourreille 3 J. Branche 4 M. Allez 5 Y. Bouhnik 6, 7 J. Filippi 8 F. Zerbib 9, 2 G. Savoye 10, 11, 12, 13 L. Vuitton 14 J. Moreau 15 A. Amiot 16 L. Beaugerie 17 E. Ricart 18 O. Dewit 19 A. Lopez-Sanroman 20 Mathurin Fumery 21 F. Carbonnel 22 A. Buisson 23 B. Coffin 24 X. Roblin 25 G. van Assche 26 M. Esteve 27 M. Farkkila 28 J.P. Gisbert 29 P. Marteau 30 S. Nahon 31 M. de Vos 32, 33 L. Peyrin-Biroulet 34, 35 J.Y. Mary 5, 36
Abstract : BACKGROUND/AIMS: Few data on the evolution of endoscopic findings are available in patients with acute severe ulcerative colitis (ASUC). The aim of this study was to describe this evolution in a prospective cohort. METHODS: Patients admitted for a steroid-refractory ASUC and included in a randomized trial comparing infliximab and cyclosporine were eligible if they achieved steroid-free clinical remission at day 98. Flexible sigmoidoscopies were performed at baseline, days 7, 42 and 98. Ulcerative colitis endoscopic index of severity (UCEIS) and its sub-scores - vascular pattern, bleeding and ulceration/erosion - were post-hoc calculated. Global endoscopic remission was defined by a UCEIS of 0, and partial endoscopic remission by any UCEIS sub-score of 0. RESULTS: Among the 55 patients analyzed (29 infliximab and 26 cyclosporine), 49 (83%) had UCEIS >= 6 at baseline at baseline. Partial endoscopic remission rates were higher for bleeding than for vascular pattern and for ulcerations/erosions at day 7 (20% vs. 4% and 5% (n = 55); p <.004 and p =.04), for bleeding and ulceration/erosion than for vascular pattern at day 42 [63% and 65% vs. 33% (n =54); p<.001 for both] and at day 98 [78% and 92% vs. 56% (n = 50); p =.007 and p <.001]. Global endoscopic remission rates at day 98 were higher in patients treated with infliximab than with cyclosporine [73% vs. 25% (n = 26 and 24); p <.001]. CONCLUSION: In steroid-refractory ASUC patients responding to a second-line medical therapy, endoscopic remission process started with bleeding remission and was not achieved in half the patients at day 98 for vascular pattern. Infliximab provided a higher endoscopic remission rate than cyclosporine at day 98.
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Submitted on : Friday, September 4, 2020 - 11:42:52 AM
Last modification on : Tuesday, September 28, 2021 - 5:12:26 PM

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D. Laharie, A. Bourreille, J. Branche, M. Allez, Y. Bouhnik, et al.. Evolution of endoscopic lesions in steroid-refractory acute severe ulcerative colitis responding to infliximab or cyclosporine. Clinical Gastroenterology and Hepatology, WB Saunders, 2020, ⟨10.1016/j.cgh.2020.08.001⟩. ⟨hal-02930225⟩

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