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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, Lancet, Elsevier, 2012, 380 (9857), pp.1909-1915. ⟨10.1016/S0140-6736(12)61084-8⟩, The Lancet, The Lancet, Elsevier, 2012, 380 (9857), pp.1909-1915. ⟨10.1016/S0140-6736(12)61084-8⟩, The Lancet, 2012, 380 (9857), pp.1909-1915. ⟨10.1016/S0140-6736(12)61084-8⟩
- Publication Year :
- 2012
- Publisher :
- HAL CCSD, 2012.
-
Abstract
- International audience; 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. 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). 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. 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. FUNDING: Association François Aupetit, Société Nationale Française de Gastroentérologie, and the International Organization for the study of Inflammatory Bowel Disease.
- Subjects :
- Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Drug Resistance
Azathioprine
Inflammatory bowel disease
law.invention
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Internal medicine
medicine
Humans
Treatment Failure
Infusions, Intravenous
Colectomy
Intention-to-treat analysis
business.industry
[CHIM.ORGA]Chemical Sciences/Organic chemistry
Anti-Inflammatory Agents, Non-Steroidal
Antibodies, Monoclonal
General Medicine
Middle Aged
medicine.disease
Ciclosporin
Ulcerative colitis
Infliximab
3. Good health
Surgery
030220 oncology & carcinogenesis
Acute Disease
Cyclosporine
030211 gastroenterology & hepatology
Colitis, Ulcerative
Female
Steroids
business
Immunosuppressive Agents
medicine.drug
Subjects
Details
- Language :
- English
- ISSN :
- 01406736 and 1474547X
- Database :
- OpenAIRE
- Journal :
- Lancet, Lancet, Elsevier, 2012, 380 (9857), pp.1909-1915. ⟨10.1016/S0140-6736(12)61084-8⟩, The Lancet, The Lancet, Elsevier, 2012, 380 (9857), pp.1909-1915. ⟨10.1016/S0140-6736(12)61084-8⟩, The Lancet, 2012, 380 (9857), pp.1909-1915. ⟨10.1016/S0140-6736(12)61084-8⟩
- Accession number :
- edsair.doi.dedup.....1a9cd821d53c45453b097b7bbcaa6704