Evolution of endoscopic lesions in steroid-refractory acute severe ulcerative colitis responding to infliximab or cyclosporine - Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte Accéder directement au contenu
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

1 CIC Bordeaux
2 Hôpital Haut-Lévêque [CHU Bordeaux]
3 Institut des Maladies de l'Appareil Digestif
4 Hôtel-Dieu de Nantes
5 Hôpital Claude Huriez [Lille]
6 AP-HP - Hopital Saint-Louis [AP-HP]
7 Hôpital Beaujon [AP-HP]
8 Hôpital l'Archet
9 Service d'Hépato-Gastroentérologie [CHU Rouen]
10 ADEN - Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau
11 Hôpital JeanMinjoz
12 Pôle Maladies de l'appareil digestif [CHU Toulouse]
13 Service de gastro-entérologie [Henri Mondor AP-HP, Créteil]
14 CHU Saint-Antoine [AP-HP]
15 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
16 CIBERehd - Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas
17 UCL - Université Catholique de Louvain = Catholic University of Louvain
18 Hospital Universitario Ramón y Cajal [Madrid]
19 PERITOX - Périnatalité et Risques Toxiques - UMR INERIS_I 1
20 Service d'Hépato Gastroenterologie [CHU Amiens-Picardie]
21 Service d'Hépato-gastro-entérologie [APHP Kremlin-Bicêtre]
22 M2iSH - Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte
23 3IHP - Infection Inflammation et Interaction Hôtes Pathogènes [CHU Clermont-Ferrand]
24 Service d'Hépatologie Gastro-entérologie [CHU Clermont-Ferrand]
25 Hôpital Louis Mourier - AP-HP [Colombes]
26 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
27 University Hospitals Leuven [Leuven]
28 Helsingin yliopisto = Helsingfors universitet = University of Helsinki
29 HUS - Helsinki University Hospital [Finland]
30 CHU Tenon [AP-HP]
31 Groupe Hospitalier Intercommunal Le Raincy-Montfermeil
32 Ghent University Hospital
33 NGERE - Nutrition-Génétique et Exposition aux Risques Environnementaux
34 Service d'Hépato-gastro-entérologie [CHRU Nancy]
35 ECSTRRA [CRESS - U1153 / UMR_A 1125] - Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation | Epidémiologie Clinique, STatistique, pour la Recherche en Santé
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.
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hal-03551241 , version 1 (09-05-2023)

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Paternité - Pas d'utilisation commerciale

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