Document Detail


Steroid-refractory ulcerative colitis: predictive factors of response to cyclosporine and validation in an independent cohort.
MedLine Citation:
PMID:  18050296     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: One-third of patients with steroid-refractory ulcerative colitis (UC) do not respond to cyclosporine and require colectomy. Since alternative pharmacological treatments for this condition are available, it is pertinent to identify factors that predict response. The objective of this study was to determine predictive factors of response prior to cyclosporine administration, with validation in an independent cohort. METHODS: The 2 cohorts of patients were identified from prospectively established databases. All patients had received 1 mg/kg/day prednisolone or equivalent for at least 5 days before cyclosporine. The efficacy measure was need of early surgery (within 3 months). RESULTS: From 1998 to 2005, 34 patients were treated in 1 institution (derivation cohort) and 38 patients in the second institution (validation cohort). Eleven patients in the derivation cohort and 9 patients in the validation cohort underwent early colectomy. Univariate analysis in the derivation cohort demonstrated a significant association of colectomy with C-reactive protein (P = 0.012) and the Ho index before initiation of cyclosporine (P = 0.013). Regression analysis showed that only the Ho index (P = 0.011) had an independent predictive value. The Ho index predicted need of colectomy, with an area under the characteristic receiver operating curve of 0.79 (95% confidence interval [CI], 0.59-0.99) in the derivation cohort and 0.74 (95% CI, 0.53-0.96) in the validation cohort. The cutoff point with the best sensitivity and specificity ratio was > or =5. CONCLUSIONS: The Ho-based predictive score is a good predictor of response to cyclosporine and avoidance of colectomy, and may aid in the indication of this treatment for management of steroid-resistant UC.
Authors:
Montserrat Aceituno; Esther García-Planella; Carolina Heredia; Yamile Zabana; Faust Feu; Eugeni Domènech; Miquel Angel Gassull; Julián Panés
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't; Validation Studies    
Journal Detail:
Title:  Inflammatory bowel diseases     Volume:  14     ISSN:  1078-0998     ISO Abbreviation:  Inflamm. Bowel Dis.     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-02-13     Completed Date:  2008-05-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9508162     Medline TA:  Inflamm Bowel Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  347-52     Citation Subset:  IM    
Affiliation:
Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBER-EHD, Barcelona, Spain.
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MeSH Terms
Descriptor/Qualifier:
Adult
Colectomy / methods*
Colitis, Ulcerative / drug therapy*,  epidemiology,  surgery
Cyclosporine / therapeutic use*
Drug Resistance
Female
Follow-Up Studies
Glucocorticoids / pharmacology*
Humans
Immunosuppressive Agents / therapeutic use*
Male
Prednisolone / pharmacology*
Prevalence
Prospective Studies
Spain / epidemiology
Chemical
Reg. No./Substance:
0/Glucocorticoids; 0/Immunosuppressive Agents; 50-24-8/Prednisolone; 59865-13-3/Cyclosporine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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