Specific Factors Predict Rescue Therapy Response in Acute Severe Ulcerative Colitis

“Acute severe ulcerative colitis is a medical emergency for which colectomy is required in patients who do not respond to rescue therapy,” wrote corresponding author Peter De Cruz, MBBS, PhD, of the Austin Health Department of Gastroenterology in Melbourne, Australia, and study coauthors. “While previous studies have predominantly focused on predicting outcome to first-line corticosteroid therapy, there is a need to understand the factors associated with response to rescue therapies in order to improve clinical outcomes.”

The review identified 42 clinical, hematological, biochemical, endoscopic, and pharmacological factors linked with rescue therapy response across a total 101 studies.

Patient age of 50 years or older, thiopurine exposure, and cytomegalovirus or Clostridioides difficile infection were associated with an increased risk of rescue therapy nonresponse, according to results. Biochemical factors linked with poorer response included an elevated C-reactive protein (CRP) of 30 mg/L or greater on admission, serum albumin of less than 30 g/L on admission, and an elevated CRP-to-albumin ratio before and after rescue.

A Mayo Endoscopic Score of 3, an Ulcerative Colitis Endoscopic Index of Severity score of 5 or higher, and other severe endoscopic findings also signaled poorer outcomes, researchers reported.

“Response to rescue therapy can be predicted by several specific factors, which would aid clinical decision-making,” researchers wrote. “Existing and emerging factors should be integrated within predictive and prognostic models to help improve clinical outcomes.”

Reference

Li Wai Suen CFD, Seah D, Choy MC, De Cruz P. Factors associated with response to rescue therapy in acute severe ulcerative colitis. Inflamm Bowel Dis. 2024;30(8):1389-1405. doi:10.1093/ibd/izad183