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Comparative Study
. 2014 Jan;20(1):14-20.
doi: 10.1097/01.MIB.0000437497.07181.05.

Rescue therapy with cyclosporine or infliximab is not associated with an increased risk for postoperative complications in patients hospitalized for severe steroid-refractory ulcerative colitis

Affiliations
Comparative Study

Rescue therapy with cyclosporine or infliximab is not associated with an increased risk for postoperative complications in patients hospitalized for severe steroid-refractory ulcerative colitis

Ryan Nelson et al. Inflamm Bowel Dis. 2014 Jan.

Abstract

Background: Cyclosporine and infliximab (IFX) are effective medical therapies for inducing remission in patients with steroid-refractory ulcerative colitis (UC). Patients with acute severe disease who do not respond to these therapies require colectomy, however, the risk of postoperative complications in such patients is not known. Analyzing patients with acute severe UC, we compared the incidence of postoperative complications in patients who failed rescue therapy with cyclosporine or IFX with that in patients who received intravenous (IV) corticosteroids alone.

Methods: We performed a retrospective cohort study of UC patients who underwent colectomy after inpatient treatment with cyclosporine plus IV corticosteroids (CsA+IVS), infliximab plus IV corticosteroids (IFX+IVS), or IV corticosteroids alone (IVS) at the University of Chicago Hospitals from October 1, 2006 to October 1, 2012. Primary endpoints were infectious, noninfectious, and total complications occurring within 30 days of colectomy.

Results: Of 78 patients, 19 were treated with CsA+IVS, 24 with IFX+IVS, 4 with both CsA and IFX+IVS, and 31 with IVS alone. Patients treated with rescue therapy plus IVS had no difference in total postoperative complications compared with those receiving IVS alone (CsA+IVS: relative risk (RR) = 0.63, 95% confidence interval (CI), 0.33-1.23; IFX+IVS: RR = 0.65, 95% CI, 0.36-1.17). There remained no difference in postoperative complications between the rescue therapy and IVS alone groups when subcategorizing overall complications into infectious (CsA+IVS: RR = 0.54, 95% CI, 0.17-1.76; IFX+IVS: RR = 0.86, 95% CI, 0.36-2.09) and noninfectious (CsA+IVS: RR = 0.88, 95% CI, 0.43-1.80; IFX+IVS: RR = 0.40, 95% CI, 0.15-1.07) causes.

Conclusions: Cyclosporine and IFX are not associated with an increased risk for postoperative complications in patients hospitalized for severe UC refractory to corticosteroids.

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Conflict of interest statement

CONFLICTS OF INTEREST

For the remaining authors, none were declared.

Figures

Figure 1
Figure 1
Schematic outlining the process by which the eligible sample size of n=78 was reached.
Figure 2
Figure 2. Relative contributions from complication subgroups
Percentage of patients in each study group – CsA+IVS, IFX+IVS, IVS alone – having either an infectious (A) or non-infectious (B) complication. Differential shading represents the relative contribution from each complication subgroup.

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