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Maintenance therapy after an episode of steroid-responsive acute severe ulcerative colitis : what is the best strategy?
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Introdução A Colite Ulcerosa é uma doença inflamatória intestinal crónica, que se caracteriza por períodos de agudização alternados com remissão. Em até 20% dos casos, podese desenvolver um quadro de colite ulcerosa (CU) grave. A melhor terapêutica de manutenção após um episódio de CU grave com resposta aos corticoides permanece por esclarecer. O nosso objetivo foi comparar a evolução clínica dos doentes tratados com diferentes regimes terapêuticos, após um internamento por CU grave. Métodos Estudo de coorte unicêntrico retrospetivo que incluiu todos os doentes internados por colite ulcerosa aguda grave, entre 2014-2022, e que responderam a corticoides, segundo os Critérios de Oxford. Os eventos a curto (<1ano) e longo (>1ano) prazo após internamento foram analisados. Para análise, foi considerado um ‘outcome’ composto definido por extensão proximal da doença, necessidade de escalar terapêutica, novo internamento ou colectomia. Resultados e Discussão Foram incluídos 32 doentes. No total, 28% dos doentes tiveram alta com 5- ASA/imunomodulador (IMM) e 72% com um agente biológico (infliximab, vedolizumab, golimumab). Durante o seguimento, 28% dos doentes precisaram de um novo curso de corticóides e 22% de escalar terapêutica, 4% apresentaram extensão proximal da doença, 13% um novo internamento e 3% de colectomia. Relativamente ao outcome composto, 47% desenvolveram pelo menos um evento a curto prazo e 31% a longo prazo. Não se verificaram diferenças nas taxas de eventos durante o primeiro ano de seguimento (48% vs 44%, p=0,863). Contudo, os doentes tratados com biológicos apresentaram uma tendência para um menor número de eventos a longo prazo (56% vs 22%, p=0,064). Conclusão Nesta coorte, os doentes tratados com biológico apresentaram uma tendência para um menor número de eventos a longo prazo, quando comparados com os doentes que foram tratados com 5-ASA ou IMM, sugerindo que uma terapêutica mais agressiva possa ser mais adequada neste contexto.
Introduction Ulcerative Colitis (UC) is a chronic inflammatory bowel disease, characterized by periods of acute flares alternating with periods of remission. Up to 20% of UC patients can develop an acute severe ulcerative colitis (ASUC) episode. The best maintenance therapy after steroid-responsive acute severe ulcerative colitis (ASUC) is still controversial. Our goal was to compare the outcomes of starting different treatment regimens in patients with steroid-responsive ASUC. Methods Retrospective unicentric cohort study including all patients hospitalized with ASUC, between 2014-2022, who responded to steroids according to Oxford Criteria. Short (<1year) and long-term (>1year) outcomes after ASUC hospitalization were assessed. The primary composite outcome was defined by proximal disease extension, therapy escalation, new hospitalization or colectomy. Results and Discussion 32 steroid-responsive patients were included. Overall, 28% of patients were discharged with 5-ASA/immunomodulator (IMM) and 72% with biologics (infliximab, vedolizumab, golimumab). During long-term follow-up, 28% of patients needed a new course of steroids and 22% therapy escalation, 4% presented proximal disease extension, 13% required a new hospitalization and 3% underwent colectomy. Regarding the composite outcomes, 47% had at least one adverse event in shortterm and 31% in long-term follow-up. No differences were found between the two groups in short-term outcomes (48 vs 44%, p=0,863). In long-term-outcomes, patients treated with biologics had a lower rate of events (56% vs 22%, p=0,064). Conclusion In our cohort, patients treated with biologics presented a trend towards a lower rate of events in the long-term, when compared to the patients treated with 5-ASA or IMM, suggesting that a more aggressive therapy could be more appropriate in this setting.
Introduction Ulcerative Colitis (UC) is a chronic inflammatory bowel disease, characterized by periods of acute flares alternating with periods of remission. Up to 20% of UC patients can develop an acute severe ulcerative colitis (ASUC) episode. The best maintenance therapy after steroid-responsive acute severe ulcerative colitis (ASUC) is still controversial. Our goal was to compare the outcomes of starting different treatment regimens in patients with steroid-responsive ASUC. Methods Retrospective unicentric cohort study including all patients hospitalized with ASUC, between 2014-2022, who responded to steroids according to Oxford Criteria. Short (<1year) and long-term (>1year) outcomes after ASUC hospitalization were assessed. The primary composite outcome was defined by proximal disease extension, therapy escalation, new hospitalization or colectomy. Results and Discussion 32 steroid-responsive patients were included. Overall, 28% of patients were discharged with 5-ASA/immunomodulator (IMM) and 72% with biologics (infliximab, vedolizumab, golimumab). During long-term follow-up, 28% of patients needed a new course of steroids and 22% therapy escalation, 4% presented proximal disease extension, 13% required a new hospitalization and 3% underwent colectomy. Regarding the composite outcomes, 47% had at least one adverse event in shortterm and 31% in long-term follow-up. No differences were found between the two groups in short-term outcomes (48 vs 44%, p=0,863). In long-term-outcomes, patients treated with biologics had a lower rate of events (56% vs 22%, p=0,064). Conclusion In our cohort, patients treated with biologics presented a trend towards a lower rate of events in the long-term, when compared to the patients treated with 5-ASA or IMM, suggesting that a more aggressive therapy could be more appropriate in this setting.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Colite ulcerosa aguda grave Resposta a corticoides Biológicos Imunossupressores Mesalamina (5-ASA) Gastroenterologia