Acute Severe Ulcerative Colitis: Optimal Strategies for Drug Therapy

다국어 초록 (Multilingual Abstract)

Acute severe ulcerative colitis (ASUC) is a life-threatening medical emergency with considerable morbidity (30% to 40%). Patients with ASUC require hospitalization for prompt medical treatment, and colectomy is considered if medical therapy fails. Corticosteroids remain the primary initial therapy, although one-third of patients do not respond to treatment. Clinical data have indicated that cyclosporine, tacrolimus, and infliximab can be used to treat patients with ASUC who do not respond to intravenous corticosteroids. The effectiveness and safety of sequential therapy have recently been reported; however, the data are not convincing. Importantly, timely decision-making with rescue therapy or surgical treatment is critical to manage ASUC without compromising the health or safety of the patients. In addition, risk stratification and the use of predictive clinical parameters have improved the clinical outcome.of ASUC. Multidisciplinary teams that include inflammatory bowel disease experts, colorectal surgeons, and other medical staff contribute to the better management of patients with ASUC. In this review, we introduce current evidence and present a clinical approach to manage ASUC.

참고문헌 (Reference)

1 Perry C, "Vedolizumab dose escalation improves therapeutic response in a subset of patients with ulcerative colitis" 66 : 2051-2058, 2021

2 Feagan BG, "Vedolizumab as induction and maintenance therapy for ulcerative colitis" 369 : 699-710, 2013

3 Kornbluth A, "Ulcerative colitis practice guidelines in adults : American College of Gastroenterology, Practice Parameters Committee" 105 : 501-523, 2010

4 Kotwani P, "Tofacitinib for rescue therapy in acute severe ulcerative colitis : a real-world experience" 14 : 1026-1028, 2020

5 Berinstein JA, "Tofacitinib for biologic-experienced hospitalized patients with acute severe ulcerative colitis : a retrospective case-control study" 19 : 2112-2120, 2021

6 Ananthakrishnan AN, "Thromboprophylaxis is associated with reduced post-hospitalization venous thromboembolic events in patients with inflammatory bowel diseases" 12 : 1905-1910, 2014

7 Harbord M, "Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 2 : current management" 11 : 769-784, 2017

8 Dinesen LC, "The pattern and outcome of acute severe colitis" 4 : 431-437, 2010

9 Nakase H, "The influence of cytokines on the complex pathology of ulcerative colitis" 21 : 103017-, 2022

10 Minami N, "Tacrolimus or infliximab for severe ulcerative colitis : short-term and longterm data from a retrospective observational study" 2 : e000021-, 2015

11 Narula N, "Systematic review : sequential rescue therapy in severe ulcerative colitis : do the benefits outweigh the risks?" 21 : 1683-1694, 2015

12 Schmidt KJ, "Short-term efficacy of tacrolimus in steroid-refractory ulcerative colitis : experience in 130 patients" 37 : 129-136, 2013

13 Lee HS, "Short-and long-term outcomes of acute severe ulcerative colitis in Korea : the 1999-2005 cohort" 21 : 1825-1831, 2015

14 Gilmore R, "Sequential use of high-dose tofacitinib after infliximab salvage therapy in acute severe ulcerative colitis" 16 : 166-168, 2022

15 Dignass A, "Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2 : current management" 6 : 991-1030, 2012

16 Nguyen GC, "Rising prevalence of venous thromboembolism and its impact on mortality among hospitalized inflammatory bowel disease patients" 103 : 2272-2280, 2008

17 Hindryckx P, "Review article : dose optimisation of infliximab for acute severe ulcerative colitis" 45 : 617-630, 2017

18 Rosen MJ, "Review article : applying pharmacokinetics to optimise dosing of anti-TNF biologics in acute severe ulcerative colitis" 41 : 1094-1103, 2015

19 Graziano F, "Rescue therapy with intensive vedolizumab optimization in a seventeen-year-old girl with acute severe ulcerative colitis" 66 : 2470-2471, 2021

20 Kobayashi T, "Rapid endoscopic improvement is important for 1-year avoidance of colectomy but not for the long-term prognosis in cyclosporine A treatment for ulcerative colitis" 45 : 1129-1137, 2010

21 Herfarth HH, "Pushing the pedal to the metal : should we accelerate infliximab therapy for patients with severe ulcerative colitis?" 13 : 336-338, 2015

22 Jain S, "Predictors of long-term outcomes in patients with acute severe colitis : a northern Indian cohort study" 33 : 615-622, 2018

23 Ho GT, "Predicting the outcome of severe ulcerative colitis : development of a novel risk score to aid early selection of patients for second-line medical therapy or surgery" 19 : 1079-1087, 2004

24 Torres J, "Predicting outcomes to optimize disease management in inflammatory bowel diseases" 10 : 1385-1394, 2016

25 Travis SP, "Predicting outcome in severe ulcerative colitis" 38 : 905-910, 1996

26 Komaki Y, "Pharmacologic therapies for severe steroid refractory hospitalized ulcerative colitis : a network meta-analysis" 32 : 1143-1151, 2017

27 Lynch RW, "Outcomes of rescue therapy in acute severe ulcerative colitis : data from the United Kingdom inflammatory bowel disease audit" 38 : 935-945, 2013

28 Miyoshi J, "Mucosal healing with oral tacrolimus is associated with favorable medium-and long-term prognosis in steroid-refractory/dependent ulcerative colitis patients" 7 : e609-e614, 2013

29 Brandse JF, "Loss of infliximab into feces is associated with lack of response to therapy in patients with severe ulcerative colitis" 149 : 350-355, 2015

30 Festa S, "Long-term outcomes of acute severe ulcerative colitis in the rescue therapy era : a multicentre cohort study" 9 : 507-516, 2021

31 Laharie D, "Long-term outcome of patients with steroid-refractory acute severe UC treated with ciclosporin or infliximab" 67 : 237-243, 2018

32 Yamamoto S, "Long-term effect of tacrolimus therapy in patients with refractory ulcerative colitis" 28 : 589-597, 2008

33 Miehsler W, "Is inflammatory bowel disease an independent and disease specific risk factor for thromboembolism?" 53 : 542-548, 2004

34 Cohen RD, "Intravenous cyclosporin in ulcerative colitis : a five-year experience" 94 : 1587-1592, 1999

35 Williams JG, "Infliximab versus ciclosporin for steroid-resistant acute severe ulcerative colitis(CONSTRUCT) : a mixed methods, open-label, pragmatic randomised trial" 1 : 15-24, 2016

36 Järnerot G, "Infliximab as rescue therapy in severe to moderately severe ulcerative colitis : a randomized, placebo-controlled study" 128 : 1805-1811, 2005

37 Baumgart DC, "Inflammatory bowel disease : clinical aspects and established and evolving therapies" 369 : 1641-1657, 2007

38 Ungar B, "Induction infliximab levels among patients with acute severe ulcerative colitis compared with patients with moderately severe ulcerative colitis" 43 : 1293-1299, 2016

39 Moskovitz DN, "Incidence of colectomy during long-term follow-up after cyclosporineinduced remission of severe ulcerative colitis" 4 : 760-765, 2006

40 Kaplan GG, "Impact of hospital volume on postoperative morbidity and mortality following a colectomy for ulcerative colitis" 134 : 680-687, 2008

41 Issa M, "Impact of Clostridium difficile on inflammatory bowel disease" 5 : 345-351, 2007

42 Mowat C, "Guidelines for the management of inflammatory bowel disease in adults" 60 : 571-607, 2011

43 Jain S, "Faecal calprotectin and UCEIS predict short-term outcomes in acute severe colitis : prospective cohort study" 11 : 1309-1316, 2017

44 Ananthakrishnan AN, "Excess hospitalisation burden associated with Clostridium difficile in patients with inflammatory bowel disease" 57 : 205-210, 2008

45 Nakase H, "Evidence-based clinical practice guidelines for inflammatory bowel disease 2020" 56 : 489-526, 2021

46 Griffiths BJ, "Evaluation of global coagulation profiles in patients with acute severe colitis : implications for thromboprophylaxis" 148 (148): S-133-, 2015

47 Seo M, "Evaluation of disease activity in patients with moderately active ulcerative colitis : comparisons between a new activity index and Truelove and Witts’ classification" 90 : 1759-1763, 1995

48 González-Huix F, "Enteral versus parenteral nutrition as adjunct therapy in acute ulcerative colitis" 88 : 227-232, 1993

49 Berinstein JA, "Efficacy of induction therapy with high-intensity tofacitinib in 4 patients with acute severe ulcerative colitis" 17 : 988-990, 2019

50 Komaki Y, "Efficacy and safety of tacrolimus therapy for active ulcerative colitis; a systematic review and meta-analysis" 10 : 484-494, 2016

51 Nalagatla N, "Effect of accelerated infliximab induction on short-and long-term outcomes of acute severe ulcerative colitis : a retrospective multicenter study and meta-analysis" 17 : 502-509, 2019

52 Lindgren SC, "Early predictors of glucocorticosteroid treatment failure in severe and moderately severe attacks of ulcerative colitis" 10 : 831-835, 1998

53 Dolinger MT, "Dual biologic and small molecule therapy for the treatment of refractory pediatric inflammatory bowel disease" 27 : 1210-1214, 2021

54 Ogata H, "Double-blind, placebo-controlled trial of oral tacrolimus(FK506)in the management of hospitalized patients with steroid-refractory ulcerative colitis" 18 : 803-808, 2012

55 Lichtiger S, "Cyclosporine in severe ulcerative colitis refractory to steroid therapy" 330 : 1841-1845, 1994

56 Truelove SC, "Cortisone in ulcerative colitis; final report on a therapeutic trial" 2 : 1041-1048, 1955

57 McIntyre PB, "Controlled trial of bowel rest in the treatment of severe acute colitis" 27 : 481-485, 1986

58 Aratari A, "Colectomy rate in acute severe ulcerative colitis in the infliximab era" 40 : 821-826, 2008

59 Laharie D, "Ciclosporin versus infliximab in patients with severe ulcerative colitis refractory to intravenous steroids : a parallel, open-label randomised controlled trial" 380 : 1909-1915, 2012

60 Lamb CA, "British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults" 68 (68): s1-s106, 2019

61 Gisbert JP, "Acute severe ulcerative colitis : state of the art treatment" 32-33 : 59-69, 2018

62 Hindryckx P, "Acute severe ulcerative colitis : from pathophysiology to clinical management" 13 : 654-664, 2016

63 Feuerstein JD, "AGA clinical practice guidelines on the management of moderate to severe ulcerative colitis" 158 : 1450-1461, 2020

64 Ogata H, "A randomised dose finding study of oral tacrolimus(FK506)therapy in refractory ulcerative colitis" 55 : 1255-1262, 2006

65 Nguyen GC, "A national survey of the prevalence and impact of Clostridium difficile infection among hospitalized inflammatory bowel disease patients" 103 : 1443-1450, 2008

66 McCurdy JD, "A model for identifying cytomegalovirus in patients with inflammatory bowel disease" 13 : 131-137, 2015

67 Cohen RD, "A comparison of the quality of life in patients with severe ulcerative colitis after total colectomy versus medical treatment with intravenous cyclosporin" 5 : 1-10, 1999