Steroid-refractory severe ulcerative colitis what are the available treatment options

Dr. Fleisher came to the Borland-Groover Clinic in 1998. Dr. Fleisher completed his medical training at Lenox Hill Hospital in New York City. Dr. Fleisher has published and presented at national meetings on new treatments in the management of inflammatory bowel disease. He is presently studying new treatment agents in the management of inflammatory bowel disease, and is an active speaker nationally in IBD. In addition, he started the first annual meeting for patients in the Jacksonville area suffering with IBD. Dr. Fleisher is the Director of the Borland-Groover Clinic Infusion Center.

Concerns regarding quality of life should be addressed: impairment of function at school, work, or in personal relationships; social and emotional support; financial resources; and adequacy of patient education regarding their disease (13). Anxiety and major depression are more prevalent in patients with IBD than in the general population, and these conditions are more pronounced in patients with greater ongoing disease activity (72, 73). Besides providing indication for specific therapies, these psychiatric diagnoses may also predict the likelihood for medication noncompliance, a frequent contributing factor to poorer clinical outcomes and greater health-care costs (74–76).

Infliximab is an effective 2nd-line therapy in acute severe UC; 85% respond by day 7. Colectomy-free survival is improved (. 50% . 76% @ 3 years comparing infliximab and placebo). Broadly, the adverse events are similar to ciclosporin. There is no trial evidence to support the preferential use of anti-TNF or ciclosporin as 2nd-line therapy. Infliximab has been assessed as a 3rd-line therapy following failure to respond to steroids and then ciclosporin; the colectomy free survival at 3, 12, 36 months was 60%, 40% & 30%, with remission in only 30%.

Oral 5-ASA is effective for mild to moderate active ulcerative colitis extending proximal to the sigmoid colon. 21 If oral 5-ASA is ineffective, the addition of topical 5-ASA can be more effective than oral treatment alone. 22 A short-term course of oral corticosteroids may be effective if the disease does not respond to combination 5-ASA therapy, or for patients in whom a more rapid response is desired. 23 Infliximab (Remicade), an intravenously administered monoclonal antibody to tumor necrosis factor-α, is effective for corticosteroid-refractory disease. 24 A recent meta-analysis of studies of azathioprine (Imuran) for treatment of active ulcerative colitis showed no statistically significant effect. 25

Steroid-refractory severe ulcerative colitis what are the available treatment options

steroid-refractory severe ulcerative colitis what are the available treatment options

Oral 5-ASA is effective for mild to moderate active ulcerative colitis extending proximal to the sigmoid colon. 21 If oral 5-ASA is ineffective, the addition of topical 5-ASA can be more effective than oral treatment alone. 22 A short-term course of oral corticosteroids may be effective if the disease does not respond to combination 5-ASA therapy, or for patients in whom a more rapid response is desired. 23 Infliximab (Remicade), an intravenously administered monoclonal antibody to tumor necrosis factor-α, is effective for corticosteroid-refractory disease. 24 A recent meta-analysis of studies of azathioprine (Imuran) for treatment of active ulcerative colitis showed no statistically significant effect. 25

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