Better outcomes needed for ASUC

While patient outcomes have improved for acute severe ulcerative colitis (ASUC), it still remains a cause of significant morbidity and potential mortality in 2017.

Dr Peter De Cruz, head of IBD at Austin Health, told Australian Gastroenterology Week that overall and elective colectomy rates had reduced but emergent colectomy rates had not seen the same decline.

“Emergent colectomy rates carry higher risks of morbidity and mortality so we really need to improve on those outcomes,” he said.

“The fact is ASUC is a very challenging clinical scenario for which treatment paradigms are evolving.”

He said infliximab and cyclosporine had been shown to have similar effectiveness as salvage therapies for steroid-refractory ASUC, including in a systematic review and meta-analysis.

Recent real world data showed 62% of patients receiving cyclosporine remained colectomy-free in the long term.  Serious adverse events were lower with cyclosporine than infliximab but there was no difference in mortality between either drug or sequential therapy.

Dr De Cruz said there needed to be more prospective, dose-optimisation studies such as the local PREDICT-UC study. Unfortunately the data to date was still inconsistent.

“We need a better feel for how we use our existing drugs, particularly infliximab, and whether or not to give it in an accelerated fashion, at higher doses, or the best combination of therapy to maintain remission.”

He told the limbic it was an exciting area to be involved in and he thought Australia was leading the way.

“The science behind the condition is very interesting especially the role of the innate and adaptive immune system and trying to understand that role in prognostication and prediction of outcomes.”

He said new therapeutic strategies were under evaluation such as the IASO trial of anakinra.

“I think with anakinra it’s too early to discern its efficacy in ASUC. It was a drug that was used in rheumatology settings and had benefits particularly for auto-inflammatory processes like gout.”

“Probably the most useful strategy will be to use our existing drugs and learn how to use them better.”

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