Programmed endoscopic follow-up examinations with eventual retreatment in patients locally injected for an acute or recent hemorrhage from a gastric or duodenal ulcer did not influence their outcome when compared to patients receiving only a second endoscopic intervention upon evidence for recurrent hemorrhage. Scheduled control endoscopies cannot be recommended after an initial successful endoscopic treatment of peptic ulcer bleeding when selection of the patients for second-look endoscopy is directed by the Forrest criteria.
Background:
The imbalance of pro‐ and anti‐inflammatory cytokines plays an important role in the pathogenesis of inflammatory bowel disease. Shifting this disturbed ratio by means of TNF‐antibodies or interferon has been shown to be helpful in treating Crohn's disease and multiple sclerosis, respectively.
Aim:
This pilot study investigated whether interferon‐β can induce clinical remission in corticoid‐refractory ulcerative colitis.
Methods:
Twenty‐five patients with steroid‐refractory active ulcerative colitis (Clinical activity index according to Rachmilewitz: 13.5 ± 5.2) were treated in an open pilot trial with 0.5 MIU human natural interferon‐β (hn‐IFN‐β) i.v. (n=18) or 1 MIU recombinant interferon‐β‐1a (r‐IFN‐β‐1‐a) s.c. (n=7) daily with the goal of induction of remission. Subsequent maintenance treatment was carried out for 52.0 ± 78.8 weeks (range 4–336 weeks) with the same dose, three times per week.
Results:
Twenty‐two of 25 patients (88%) went into remission during induction treatment (hn‐IFN‐β 16/18, r‐IFN‐β‐1a 6/7). Mean time to response was 3.0 ± 1.3 weeks. Mean length of remission was 13.0 ± 19.7 months. Only eight of 22 patients in remission relapsed during maintenance treatment. Five of these went into remission again after increasing the dose. Adverse events consisted of slight to moderate flu‐like symptoms and slight to moderate hair loss in five of 15 female patients.
Conclusion:
Although this open pilot study included only a small number of patients, the high response rate suggests that interferon‐β may be a safe and effective treatment for steroid‐refractory active ulcerative colitis.
This patient education program was not able to increase disease-related knowledge or psychosocial variables in patients with IBD. However, most of the patients were very satisfied with the education program, since as judged by their own assessment it helped them to act responsibly for themselves and their disease.
nIFN-beta may be a safe and effective alternative to induce and maintain remissions in patients with steroid refractory active UC. To validate the presented results, its effect has to be investigated in a randomized, placebo-controlled dose-finding trial.
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