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Abstract

We thank Fragaki et al for their comment about our study on a combined approach between calcineurin inhibitors and vedolizumab for patients with refractory ulcerative colitis (UC).1Pellet G. et al.Clin Gastroenterol Hepatol. 2019; 17: 494-501Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar We agree that identifying predictors of colectomy in UC could be very helpful for clinical guidance. However, using colectomy as the only outcome has several limitations. First, patients with UC may undergo colectomy for various clinical indications. The 3 current indications for surgery in UC are acute severe flare, non-severe disease refractory to medical treatment, and neoplastic transformation. Moreover, because of the dramatic improvement in the medical management of UC in the last 2 decades, rates of colectomy for the first 2 indications are likely to decrease with time.2Eriksson C. et al.Aliment Pharmacol Ther. 2017; 46: 748-757Crossref PubMed Scopus (45) Google Scholar, 3Kaplan G.G. et al.Am J Gastroenterol. 2012; 107: 1879-1887Crossref PubMed Scopus (140) Google Scholar Second, colectomy in UC may vary a lot between countries and centers, as shown in multicenter European cohort study showing 10-year cumulative colectomy rates that ranged from 3.9% in southern countries to 10.4% in the northern countries.4Hoie O. et al.Gastroenterology. 2007; 132: 507-515Abstract Full Text Full Text PDF PubMed Scopus (225) Google Scholar This suggests that decision to proceed with colectomy also depends on factors such as center’s experience, access to medical therapies, or patient’s wish to proceed with surgery. Thus, rather than predicting risk of colectomy in UC, it would be better to predict treatment efficacy, as it has been defined with intravenous steroids in acute severe UC on the basis of number of stools and C-reactive protein level at day 3.5Travis S. et al.Gut. 1996; 38: 905-910Crossref PubMed Scopus (601) Google Scholar Risk Factors of Colectomy in Patients With Refractory Ulcerative Colitis Under Calcineurin Inhibitors Combined With VedolizumabClinical Gastroenterology and HepatologyVol. 17Issue 6PreviewWe have read with great interest the recently published article by Pellet et al.1 The authors assessed the efficacy and safety of calcineurin inhibitors as an induction therapy combined with vedolizumab as a maintenance therapy in a cohort of patients with steroid and anti–tumor necrosis factor–refractory ulcerative colitis (UC), using colectomy-free survival as the primary end point. Interestingly, this retrospective study identified the female sex, the presence of hemoglobin (Hb) greater than 11.2 g/dL, age, and concomitant immunosuppressant as baseline factors associated with colectomy. Full-Text PDF