Third-line rescue therapy averts colectomy for some patients with acute severe ulcerative colitis

Third-line rescue therapy appears to be a promising therapeutic strategy in acute severe ulcerative colitis, with a recent study showing that such an approach helps avoid colectomy in most patients.

In the multicentre retrospective cohort study, researchers recruited patients with acute severe ulcerative colitis refractory to intravenous steroids. These patients had to have shown no response to infliximab or ciclosporin and received a third-line treatment during the same hospitalization. Those who discontinued second-line treatment due to disease activity or adverse events (AEs) were eligible.

A total of 78 patients were included in the study. The primary outcome of short-term colectomy-free survival was assessed using logistic regression analysis. Kaplan–Meier curves and Cox regression models facilitated long-term assessment.

Of the patients, 32 received infliximab and 46 received ciclosporin as second-line rescue treatment. For third-line treatment, infliximab was given in 45 patients (58 percent), ciclosporin in 17 (22 percent), tofacitinib in 13 (17 percent), and ustekinumab in three (3.8 percent).

Over a median follow-up of 21 weeks, 29 patients (37 percent) underwent colectomy. Clinical remission was achieved by 32 patients at 12 weeks and by 18 patients at 52 weeks. At the last follow-up visit, 25 patients were still undergoing the third-line rescue treatment, while 12 were able to stop it after achieving remission.

AEs were documented in 26 patients (33 percent). There were two cases of death recorded, with one occurring after colectomy.