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Article Dans Une Revue Clinical Gastroenterology and Hepatology Année : 2021

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

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Matthieu Allez
Jerome Filippi
  • Fonction : Auteur

Résumé

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.

Dates et versions

hal-03551241 , version 1 (01-02-2022)

Identifiants

Citer

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, 2021, 19 (6), pp.1180-1188.e4. ⟨10.1016/j.cgh.2020.08.001⟩. ⟨hal-03551241⟩
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