Efficacy of Induction Therapy With Calcineurin Inhibitors in Combination With Ustekinumab for Acute Severe Ulcerative Colitis

Veyrard, Pauline; Pellet, Gauthier; Laharie, David; Nachury, Maria; Juillerat, Pascal; Roblin, Xavier

doi:10.1016/j.cgh.2022.03.008

Cited by 13 publications

(12 citation statements)

References 7 publications

(7 reference statements)

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“…In addition, for patients with previous failure of anti-TNF-α therapy, we have data from a small number of observational (mostly retrospective) studies that suggest the possibility of using vedolizumab or ustekinumab (instead of thiopurines) as maintenance therapy in patients successfully treated with ciclosporin for ASUC [ 99 , 100 ].…”

Section: Acute Severe Ulcerative Colitis (Asuc)mentioning

confidence: 99%

“…As mentioned in the comment on Recommendation No. 16, there is only isolated source of evidence, so far of low quality, that vedolizumab or ustekinumab (instead of thiopurines) can be used as maintenance therapy in patients who have been successfully treated with ciclosporin, but these observations mainly apply to patients with previous failure of anti-TNF-a therapy [99,100]. The consequence of numerous clinical trials is the approval of new drugs for the treatment of UC.…”

Section: Acute Severe Ulcerative Colitis (Asuc)mentioning

confidence: 99%

See 1 more Smart Citation

Guidelines for the management of ulcerative colitis. Recommendations of the Polish Society of Gastroenterology and the Polish National Consultant in Gastroenterology

Eder¹,

Łodyga²,

Gawron-Kiszka³

et al. 2023

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This paper is an update of the diagnostic and therapeutic recommendations of the National Consultant for Gastroenterology and the Polish Society of Gastroenterology from 2013. It contains 49 recommendations for the diagnosis and treatment, both pharmacological and surgical, of ulcerative colitis in adults. The guidelines were developed by a group of experts appointed by the Polish Society of Gastroenterology and the National Consultant in the field of Gastroenterology. The methodology related to the GRADE methodology was used to assess the quality of available evidence and the strength of therapeutic recommendations. The degree of expert support for the proposed statements was assessed on a 6-point Likert scale. Voting results, together with comments, are included with each statement.

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Section: Acute Severe Ulcerative Colitis (Asuc)mentioning

confidence: 99%

Section: Acute Severe Ulcerative Colitis (Asuc)mentioning

confidence: 99%

Guidelines for the management of ulcerative colitis. Recommendations of the Polish Society of Gastroenterology and the Polish National Consultant in Gastroenterology

Eder¹,

Łodyga²,

Gawron-Kiszka³

et al. 2023

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“…Newer agents such as vedolizumab, ustekinumab, and ozanimod have been studied in ASUC but largely as maintenance therapy following a cyclosporine bridge [44,46,[71][72][73][74]. Unfortunately, interim futility analysis of a multicenter trial of interleukin-1 blockade with anakinra did not reduce the need for rescue therapy or colectomy compared with placebo [75,76].…”

Section: Ifxmentioning

confidence: 99%

In-hospital management of inflammatory bowel disease

Berinstein

Aintabi

Higgins

2023

Current Opinion in Gastroenterology

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Purpose of reviewThe management of hospitalized patients with inflammatory bowel disease (IBD) is complex. Despite considerable therapeutic advancements in outpatient ulcerative colitis and Crohn's disease management, the in-hospital management continues to lag with suboptimal outcomes. The purpose of this review is to provide a brief overview of our approach to managing patients hospitalized with acute severe ulcerative colitis (ASUC) and Crohn's disease-related complications, followed by a summary of emerging evidence for new management approaches.Recent findingsASUC has seen the emergence of well validated prognostic models for colectomy as well as the development of novel treatment strategies such as accelerated infliximab dosing, Janus kinase inhibitor therapy, and sequential therapy, yet the rate of colectomy for steroid-refractory ASUC has not meaningfully improved. Crohn's disease has seen the development of better diagnostic tools, early Crohn's disease-related complication stratification and identification, as well as better surgical techniques, yet the rates of hospitalization and development of Crohn's disease-related complications remain high.SummarySignificant progress has been made in the in-hospital IBD management; however, both the management of ASUC and hospitalized Crohn's disease remain a challenge with suboptimal outcomes. Critical knowledge gaps still exist, and dedicated studies in hospitalized patients with IBD are needed to address them.

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“…More recently, given the increasing exposure to anti-TNF and vedolizumab, a small retrospective study of 10 patients evaluated the safety and efficacy of CNIs as a bridge to ustekinumab in ASUC. 41 Tacrolimus has also been considered in this clinical setting with data of key cohorts studying CNIs presented in Table 5.…”

Section: Ciclosporin As a Bridge To Maintenance Therapymentioning

confidence: 99%

Review article: Updated management of acute severe ulcerative colitis: From steroids to novel medical strategies

Calméjane

Laharie

Kirchgesner³

et al. 2023

UEG Journal

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Acute severe ulcerative colitis (ASUC) occurs in up to 25% of patients with ulcerative colitis (UC). Therapeutic approaches have evolved during the past years with the increasing bio exposure of admitted patients and the extension of the number of approved drugs for UC. In this review, we aimed to summarize the latest evidence in short‐term and long‐term medical strategies for ASUC. In addition to general principles such as venous thromboembolism prophylaxis, screening for triggering and worsening factors and close monitoring, first‐line therapy for ASUC remains intravenous corticosteroids. In naive patients, the optimum maintenance strategy for steroid‐responding patients does not necessarily include biologics. Second‐line therapy includes infliximab or calcineurin inhibitors (CNIs) with similar short‐ and long‐term colectomy rates. Despite its pathophysiological relevance, there is insufficient evidence to promote intensified induction with infliximab. Prior treatment exposure is a cornerstone for guiding therapeutic choice of short‐ and long‐term therapies in the context of ASUC: in anti‐TNF exposed patients, CNIs may be favored as a bridge therapy to vedolizumab or ustekinumab. Third‐line salvage therapy could be a therapeutic option in selected patients referred to expert centers. Additionally, evidence is accumulating regarding the use of tofacitinib in ASUC.

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Efficacy of Induction Therapy With Calcineurin Inhibitors in Combination With Ustekinumab for Acute Severe Ulcerative Colitis

Cited by 13 publications

References 7 publications

Guidelines for the management of ulcerative colitis. Recommendations of the Polish Society of Gastroenterology and the Polish National Consultant in Gastroenterology

Guidelines for the management of ulcerative colitis. Recommendations of the Polish Society of Gastroenterology and the Polish National Consultant in Gastroenterology

In-hospital management of inflammatory bowel disease

Review article: Updated management of acute severe ulcerative colitis: From steroids to novel medical strategies

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