Abstract
BackgroundIntravenous corticosteroid is the mainstay for managing acute severe ulcerative colitis, but one-third of patients do not respond to intravenous corticosteroid. Tacrolimus, a salvage therapy before colectomy, is usually orally administered, though its bioavailability is low compared intravenous administration. The efficacy of intravenous tacrolimus has not been widely studied.AimTo determine the efficacy and safety of intravenous tacrolimus for the treatment of acute severe ulcerative colitis.MethodsEighty-seven hospitalized acute severe ulcerative colitis patients were enrolled for a prospective cohort study between 2009 and 2017. Sixty-five patients received intravenous tacrolimus and 22 received oral tacrolimus. The primary outcome was the achievement of clinical remission within 2 weeks. Relapse and colectomy incidence and adverse events were assessed at 24 weeks.ResultsResponse rates of both treatments exceeded 50% but were not significantly different. The remission rate was higher in intravenous tacrolimus compared with oral tacrolimus. At 24 weeks, oral and intravenous tacrolimus showed similar relapse-free survival rates; however, colectomy-free survival rates were higher in intravenous tacrolimus compared with oral tacrolimus.ConclusionsPatients receiving intravenous tacrolimus achieved superior remission and colectomy-free survival rates compared with patients receiving oral tacrolimus. Safety was similar between the two treatments.
Highlights
Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic inflammation of the colon
The remission rate was higher in intravenous tacrolimus compared with oral tacrolimus
At 24 weeks, oral and intravenous tacrolimus showed similar relapse-free survival rates; colectomy-free survival rates were higher in intravenous tacrolimus compared with oral tacrolimus
Summary
Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic inflammation of the colon. More than 20% of patients with UC will develop acute severe ulcerative colitis (ASUC) and of those patients, up to 30% fail to adequately respond to high-dose intravenous. The use of CNIs versus infliximab for induction of salvage therapy is controversial. The increasing use of infliximab or other anti-TNF-α antibodies can lead the patients to fail anti-TNF-α therapies or become intolerant due to adverse events. CNIs can still be an alternative option for ASUC patients to escape acute severe disease and emergent colectomies can serve as a bridging therapy for maintenance. Intravenous corticosteroid is the mainstay for managing acute severe ulcerative colitis, but one-third of patients do not respond to intravenous corticosteroid. Tacrolimus, a salvage therapy before colectomy, is usually orally administered, though its bioavailability is low compared intravenous administration. The efficacy of intravenous tacrolimus has not been widely studied
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
