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Ciclosporin versus infliximab in patients with severe ulcerative colitis refractory to intravenous steroids: a parallel, open-label randomised controlled trial.
- Source :
-
Lancet (London, England) [Lancet] 2012 Dec 01; Vol. 380 (9857), pp. 1909-15. Date of Electronic Publication: 2012 Oct 10. - Publication Year :
- 2012
-
Abstract
- Background: Ciclosporin and infliximab are potential rescue treatments to avoid colectomy in patients with acute severe ulcerative colitis refractory to intravenous corticosteroids. We compared the efficacy and safety of these drugs for this indication.<br />Methods: In this parallel, open-label, randomised controlled trial, patients were aged at least 18 years, had an acute severe flare of ulcerative colitis defined by a Lichtiger score greater than 10 points, and had been given an unsuccessful course of high-dose intravenous steroids. None of the patients had previously received ciclosporin or infliximab. Between June 1, 2007, and Aug 31, 2010, patients at 27 European centres were randomly assigned (via computer-derived permutation tables; 1:1) to receive either intravenous ciclosporin (2 mg/kg per day for 1 week, followed by oral drug until day 98) or infliximab (5 mg/kg on days 0, 14, and 42). In both groups, azathioprine was started at day 7 in patients with a clinical response. Neither patients nor investigators were masked to study treatment. The primary efficacy outcome was treatment failure defined by absence of a clinical response at day 7, a relapse between day 7 and day 98, absence of steroid-free remission at day 98, a severe adverse event leading to treatment interruption, colectomy, or death. Analysis was by intention to treat. This trial is registered with EudraCT (2006-005299-42) and ClinicalTrials.gov (NCT00542152).<br />Findings: 115 patients were randomly assigned; 58 patients were allocated to receive ciclosporin and 57 to receive infliximab. Treatment failure occurred in 35 (60%) patients given ciclosporin and 31 (54%) given infliximab (absolute risk difference 6%; 95% CI -7 to 19; p=0·52). Nine (16%) patients in the ciclosporin group and 14 (25%) in the infliximab group had severe adverse events.<br />Interpretation: Ciclosporin was not more effective than infliximab in patients with acute severe ulcerative colitis refractory to intravenous steroids. In clinical practice, treatment choice should be guided by physician and centre experience.<br />Funding: Association François Aupetit, Société Nationale Française de Gastroentérologie, and the International Organization for the study of Inflammatory Bowel Disease.<br /> (Copyright © 2012 Elsevier Ltd. All rights reserved.)
- Subjects :
- Acute Disease
Adult
Drug Resistance
Female
Humans
Infliximab
Infusions, Intravenous
Male
Middle Aged
Treatment Failure
Anti-Inflammatory Agents, Non-Steroidal therapeutic use
Antibodies, Monoclonal therapeutic use
Colitis, Ulcerative drug therapy
Cyclosporine therapeutic use
Immunosuppressive Agents therapeutic use
Steroids administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1474-547X
- Volume :
- 380
- Issue :
- 9857
- Database :
- MEDLINE
- Journal :
- Lancet (London, England)
- Publication Type :
- Academic Journal
- Accession number :
- 23063316
- Full Text :
- https://doi.org/10.1016/S0140-6736(12)61084-8