Managing paediatric acute severe ulcerative colitis according to the 2011 ECCO-ESPGHAN guidelines: Efficacy of infliximab as a rescue therapy. Issue 6 (June 2015)

• Record Type: Journal Article
• Authors: Aloi, Marina; D'Arcangelo, Giulia; Capponi, Martina; Nuti, Federica; Vassallo, Francesca; Civitelli, Fortunata; Oliva, Salvatore; Pagliaro, Giuseppe; Cucchiara, Salvatore
• Is Part Of: Digestive and liver disease. Volume 47:Issue 6(2015)
• Page Start: 455
• Page End: 459
• Publication Date: 2015-06
• Subjects: Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2015.01.156
• Languages: English
• ISSNs: 1590-8658

Abstract

<abstract abstract-type="author" id="abs0005"> <title id="sect0005">Abstract</title> <sec> <title id="sect0010">Background</title> <p id="spar0005">The effectiveness of medical therapy in paediatric acute severe colitis is scarcely described. We aimed to assess the efficacy of infliximab in children prospectively enrolled at Sapienza University of Rome between May 2010 and 2012.</p> </sec> <sec> <title id="sect0015">Methods</title> <p id="spar0010">Clinical assessment and laboratory data were recorded at admission and at day 3 and 5. All patients received corticosteroids; infliximab was administered in refractory patients. Colectomy rate was assessed at 2-year follow-up.</p> </sec> <sec> <title id="sect0020">Results</title> <p id="spar0015">Thirty-one patients (mean age 10.6 ± 4.9 years, 52% females) were included: 21 responded to corticosteroids (68%), 10 were refractory and received infliximab (32%). Among the latter, 2 required urgent colectomy (20%); 80% responded, however 50% of these required elective colectomy during follow-up. Patients refractory to corticosteroids showed a significantly shorter interval from ulcerative colitis diagnosis to acute severe colitis compared to responders (7.4 ± 9.6 vs. 23.1 ± 21.6 months, respectively; <italic>p</italic> = 0.01), and a higher rate of colectomy at follow-up (50% vs. 14%, respectively; <italic>p</italic> = 0.007). More than 2 courses of corticosteroids before acute severe colitis were predictive of surgical need (OR 4.4).</p> </sec> <sec> <title id="sect0025">Conclusion</title> <p id="spar0020">Despite its short-term efficacy, infliximab did not modify the long-term surgical rate of paediatric acute severe colitis in our cohort. Children with an early severe colitis commonly need a second-line therapy, whilst frequent courses of corticosteroids are predictive of a poor outcome.</p> </sec> </abstract>