SNFGE SNFGE
 
Thématique :
- MICI
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Vered ABITBOL-SELINGER
Coup de coeur :
 
 
The American Journal of Gastroenterology
  2017/11  
 
  2017 Nov;112(11):1709-1718.  
  doi: 10.1038/ajg.2017.180.  
 
  Long-Term Efficacy and Safety of Cyclosporine in a Cohort of Steroid-Refractory Acute Severe Ulcerative Colitis Patients from the ENEIDA Registry (1989–2013): A Nationwide Multicenter Study  
 
  Ordás I, Domènech E, Mañosa M, García-Sánchez V, Iglesias-Flores E, Peñalva M, Cañas-Ventura A, Merino O, Fernández-Bañares F, Gomollón F, Vera M, Gutiérrez A, Garcia-Planella E, Chaparro M, Aguas M, Gento E, Muñoz F, Aguirresarobe M, Muñoz C, Fernández L, Calvet X, Jiménez CE, Montoro MA, Mir A, De Castro ML, García-Sepulcre MF, Bermejo F, Panés J, Esteve M  
  https://www.ncbi.nlm.nih.gov/pubmed/28675163  
 
 

Abstract

OBJECTIVES:

To determine the efficacy and safety of cyclosporine (CyA) in a large national registry-based population of patients with steroid-refractory (SR) acute severe ulcerative colitis (ASUC) and to establish predictors of efficacy and adverse events.

METHODS:

Multicenter study of SR-ASUC treated with CyA, based on data from the ENEIDA registry. SR-ASUC patients treated with infliximab (IFX) or sequential rescue therapy (CyA-IFX or IFX-CyA) were used as comparators.

RESULTS:

Of 740 SR-ASUC patients, 377 received CyA, 131 IFX and 63 sequential rescue therapy. The cumulative colectomy rate was higher in the CyA (24.1%) and sequential therapy (32.7%) than in the IFX group (14.5%; P=0.01) at 3 months and 5 years. There were no differences in early and late colectomy between CyA and IFX in patients treated after 2005. 62% of patients receiving CyA remained colectomy-free in the long term (median 71 months). There were no differences in mortality between CyA (2.4%), IFX (1.5%) and sequential therapy (0%; P=0.771). The proportion of patients with serious adverse events (SAEs) was lower in CyA (15.4%) than in IFX treated patients (26.5%) or sequential therapy (33.4%; P<0.001). This difference in favor of CyA was maintained when only patients treated after 2005 were analyzed.

CONCLUSIONS:

Treatment with CyA showed a lower rate of SAE and a similar efficacy to that of IFX thereby supporting the use of either CyA or IFX in SR-ASUC. In addition, the risk-benefit of sequential CyA-IFX for CyA non-responders is acceptable.

 

 
Question posée
 
Quelles sont l’efficacité et la tolérance de la cyclosporine (Cyclo) par rapport à l’infliximab (IFX) et au traitement séquentiel Cyclo-IFX dans la colite aiguë grave ?
 
Question posée
 
Le taux d’évènements indésirables était inférieur dans le groupe Cyclo pour une efficacité équivalente à celle de l’IFX. Le risque-bénéfice du traitement séquentiel Cyclo-IFX pour les non répondeurs à la Cyclo est acceptable.
 
Commentaires

Etude menée par le groupe espagnol GETECCU sur les données d’une large cohorte prospective multicentrique (25 centres, 740 patient). Ces données d’efficacité et de tolérance nous rappellent la place actuelle de la cyclosporine dans le traitement de la colite aiguë grave. 

 
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