Ciclosporin vs Infliximab: Which is Best for Steroid-Refractory UC?

Ciclosporin and infliximab are equally safe and effective for the long-term treatment of steroid-refractory acute severe ulcerative colitis (ASUC), according to a recent study.

These findings add to previous evidence suggesting that both drugs were safe and effective for short-term use as second-line therapies for the condition.
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For their study, 115 patients with steroid-refractory ASUC were randomly assigned to receive ciclosporin or infliximab in association with azathioprine at 29 European centers between 2007 and 2010. Patients were followed until death or up to January 2015 (median follow-up 5.4 years).

The Kaplan-Meier method was used to estimate colectomy-free survival rates at 1 and 5 years, as well as changes in therapy. These factors were subsequently compared between initial treatment groups via log-rank test.

Findings showed that colectomy-free survival rates at 1 and 5 years were 70.9% and 61.5%, respectively, in the ciclosporin group and 69.1% and 65.1%, respectively, in the infliximab group. The cumulative incidence of first infliximab use in the ciclosporin group was 45.7% at 1 year and 57.1% at 5 years. Four patients in the infliximab group were later switched to ciclosporin.

The researchers noted that 3 patients died over the course of follow-up. However, none of these deaths were directly associated with UC or its treatment.

“In this cohort of patients with steroid-refractory ASUC initially treated by ciclosporin or infliximab, long-term colectomy-free survival was independent from initial treatment,” the researchers concluded. “These long-term results further confirm a similar efficacy and good safety profiles of both drugs and do not favor one drug over the other.”

—Christina Vogt

Reference:

Laharie D, Bourreille A, Branche J, et al. Long-term outcome of patients with steroid-refractory acute severe UC treated with ciclosporin or infliximab [Published online January 8, 2018]. Gut. https://dx.doi.org/10.1136/gutjnl-2016-313060.