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

David Laharie 1, 2 Arnaud Bourreille 3, 4 Julien Branche 5 Matthieu Allez 6 Yoram Bouhnik 7 Jerome Filippi 8 Frank Zerbib 2, 1 Guillaume Savoye 9, 10 Lucine Vuitton 11 Jacques Moreau 12 Aurelien Amiot 13 Laurent Beaugerie 14, 15 Elena Ricart 16 Olivier Dewit 17 Antonio Lopez-Sanroman 18 Mathurin Fumery 19, 20 Franck Carbonnel 21 Anthony Buisson 22, 23, 24 Benoit Coffin 25 Xavier Roblin 26 Gert Assche 27 Maria Esteve 16 Martti Farkkila 28, 29 Javier P. Gisbert 16 Philippe Marteau 30 Stephane Nahon 31 Martine Vos 32 Laurent Peyrin-Biroulet 33, 34 Jean-Yves Mary 35
35 CRESS - U1153 - Equipe 2 : ECSTRA - Epidémiologie Clinique, STatistique, pour la Recherche en Santé
CRESS (U1153 / UMR_A_1125 / UMR_S_1153) - Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité
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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https://hal-u-picardie.archives-ouvertes.fr/hal-03551241
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Soumis le : mardi 1 février 2022 - 15:13:28
Dernière modification le : mardi 3 mai 2022 - 18:26:04

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David Laharie, Arnaud Bourreille, Julien Branche, Matthieu Allez, Yoram 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, 2021, 19 (6), pp.1180-1188.e4. ⟨10.1016/j.cgh.2020.08.001⟩. ⟨hal-03551241⟩

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