Advanced Therapies for Patients With Severe Ulcerative Colitis

Hospitalized patients with acute severe ulcerative colitis (ASUC) may benefit from advanced therapies (AT), but their efficacy diminishes when used as second-line treatments, according to a multicenter observational cohort study published in the Journal of Gastroenterology.

Researchers examined the short-term outcomes of 221 hospitalized patients treated with corticosteroids (CS) and various ATs, revealing insights that could guide future management strategies. Among the 120 patients receiving CS as first-line therapy, clinical remission (CR) rates were 22.5% by Day 7 and 35.0% by Day 14. In contrast, the 101 patients who received ATs—including infliximab, tofacitinib, vedolizumab, and others—as first-line therapy achieved CR rates of 16.8% on Day 7 and 29.7% on Day 14. Most of these patients had a history of frequent recurrences or were CS-dependent.

Patients who switched to ATs after initial CS treatment experienced significantly better remission rates (34.0% by Day 14) than those who increased their CS dosage (10.7%, P = 0.020), after being treated with CS before being hospitalized. However, second-use ATs yielded limited success, with no CR at Day 7 and only 12% by Day 14.

“Most first-use ATs were effective for patients with ASUC, while second-use ATs might have had limited benefits in inducing CR,” concluded the study authors. “These findings may contribute to considerations for the management of hospitalized patients.”

This study provides valuable real-world data on the efficacy of ATs in ASUC and highlights the need for early, targeted therapy to maximize clinical remission and improve patient outcomes.

Reference:

Naganuma M, Kobayashi T, Kunisaki R, et al. Real-world efficacy and safety of advanced therapies in hospitalized patients with ulcerative colitis. J Gastroenterol. 2023;58(12):1198-1210. doi:10.1007/s00535-023-02048-w