Response to Corticosteroid Therapy in Ulcerative Colitis
Response to Corticosteroid Therapy in Ulcerative Colitis
Background and Aims: Both clinical outcomes and factors predictive for poor response after an initial course of corticosteroids have not yet been well established in the treatment of moderate to severe ulcerative colitis (UC). We therefore evaluated the short- and long-term effects of corticosteroids and prognostic factors in UC patients after such therapy.
Methods: We recruited consecutive patients who had moderate to severe UC and were treated with the first course of systemic corticosteroids between November 1996 and December 2007 using the database of Severance Hospital in Seoul, Korea. We then evaluated clinical outcomes at 1 month, 3 months, and 1 year after the initiation of corticosteroid treatment.
Results: Our study included a total of 177 patients. At 1 month, complete remission was achieved in 70 patients (39.5%) and partial remission in 88 (49.7%). Fifteen patients (8.5%) were refractory to the treatment, and four (2.3%) underwent proctocolectomy. We observed prolonged response in 111 (64.9%) at 3 months and 95 (59.4%) patients at 1 year, corticosteroid dependency in 49 (28.7%) and 51 (31.9%) patients, and no response in 11 (6.4%) and 14 (8.7%) patients. A higher initial Mayo score was found to be the only poor prognostic factor at 1 month (P = 0.032) and 1 year (P < 0.001).
Conclusions: Our data showed that most Korean patients with active UC responded well to the first course of corticosteroid treatment. However, a considerable number of patients eventually turned out to be refractory to or dependent on this therapy. The initial higher Mayo score was strongly associated with poor outcomes.
Ulcerative colitis (UC) is an inflammatory bowel disease of uncertain etiology that is characterized by recurring episodes of inflammation limited to the mucosal or submucosal layers of the colon. The overall chance of acute exacerbation in patients with UC is approximately 50%. Mortality and morbidity outcomes of patients who suffer from active UC have become more favorable since the introduction of corticosteroids as a treatment option for the flare up of UC in 1955. However, approximately one-quarter of patients remain steroid dependent or refractory. In order to overcome this problem, many researchers have investigated the adequate dosage, duration, and route of corticosteroid administration, and have aimed to identify predictive factors for the response of active UC to corticosteroids over the past several decades. Furthermore, various drugs that are helpful to avoid steroid dependency or refractoriness have become available, including azathioprine in 1974, cyclosporine in 1984, tacrolimus in 2002, and infliximab in 2005. Colectomy could also be delayed by such drugs. Nevertheless, at present, it is clear that corticosteroids remain a therapy of choice for active UC, and that these alternative drugs are considered as a secondary treatment.
To our knowledge, few papers have described the natural courses of patients after administering a first course of corticosteroids. Furthermore, most of the studies were investigated in Western countries. The natural course of UC appears to differ somewhat in Asians compared to Western populations, in that Asian populations show a milder clinical course, lower relapse rate, and lower colectomy rate.
In the present study, we report hospital-based, 1-year clinical outcomes of Korean active UC patients who received their first course of corticosteroids concomitantly with 5-aminosalicylic acid (5-ASA) or sulfasalazine. Moreover, we sought to identify predictive factors associated with steroid responsiveness in such patients.
Abstract and Introduction
Abstract
Background and Aims: Both clinical outcomes and factors predictive for poor response after an initial course of corticosteroids have not yet been well established in the treatment of moderate to severe ulcerative colitis (UC). We therefore evaluated the short- and long-term effects of corticosteroids and prognostic factors in UC patients after such therapy.
Methods: We recruited consecutive patients who had moderate to severe UC and were treated with the first course of systemic corticosteroids between November 1996 and December 2007 using the database of Severance Hospital in Seoul, Korea. We then evaluated clinical outcomes at 1 month, 3 months, and 1 year after the initiation of corticosteroid treatment.
Results: Our study included a total of 177 patients. At 1 month, complete remission was achieved in 70 patients (39.5%) and partial remission in 88 (49.7%). Fifteen patients (8.5%) were refractory to the treatment, and four (2.3%) underwent proctocolectomy. We observed prolonged response in 111 (64.9%) at 3 months and 95 (59.4%) patients at 1 year, corticosteroid dependency in 49 (28.7%) and 51 (31.9%) patients, and no response in 11 (6.4%) and 14 (8.7%) patients. A higher initial Mayo score was found to be the only poor prognostic factor at 1 month (P = 0.032) and 1 year (P < 0.001).
Conclusions: Our data showed that most Korean patients with active UC responded well to the first course of corticosteroid treatment. However, a considerable number of patients eventually turned out to be refractory to or dependent on this therapy. The initial higher Mayo score was strongly associated with poor outcomes.
Introduction
Ulcerative colitis (UC) is an inflammatory bowel disease of uncertain etiology that is characterized by recurring episodes of inflammation limited to the mucosal or submucosal layers of the colon. The overall chance of acute exacerbation in patients with UC is approximately 50%. Mortality and morbidity outcomes of patients who suffer from active UC have become more favorable since the introduction of corticosteroids as a treatment option for the flare up of UC in 1955. However, approximately one-quarter of patients remain steroid dependent or refractory. In order to overcome this problem, many researchers have investigated the adequate dosage, duration, and route of corticosteroid administration, and have aimed to identify predictive factors for the response of active UC to corticosteroids over the past several decades. Furthermore, various drugs that are helpful to avoid steroid dependency or refractoriness have become available, including azathioprine in 1974, cyclosporine in 1984, tacrolimus in 2002, and infliximab in 2005. Colectomy could also be delayed by such drugs. Nevertheless, at present, it is clear that corticosteroids remain a therapy of choice for active UC, and that these alternative drugs are considered as a secondary treatment.
To our knowledge, few papers have described the natural courses of patients after administering a first course of corticosteroids. Furthermore, most of the studies were investigated in Western countries. The natural course of UC appears to differ somewhat in Asians compared to Western populations, in that Asian populations show a milder clinical course, lower relapse rate, and lower colectomy rate.
In the present study, we report hospital-based, 1-year clinical outcomes of Korean active UC patients who received their first course of corticosteroids concomitantly with 5-aminosalicylic acid (5-ASA) or sulfasalazine. Moreover, we sought to identify predictive factors associated with steroid responsiveness in such patients.