Clinical outcomes and factors for response prediction after intravenous corticosteroid therapy in oral corticosteroid-refractory active ulcerative colitis

Abstract

PURPOSE: Clinical outcomes and factors predictive of favorable response after intravenous corticosteroids following oral corticosteroid failure have not yet been established in the treatment of moderate to severe ulcerative colitis (UC). We therefore evaluated the outcomes and prognostic factors in UC patients after such therapy.METHODS: Consecutive patients with moderate to severe UC who had been treated with a course of intravenous corticosteroids after oral corticosteroid therapy failure between January 1996 and July 2010 were recruited at Severance Hospital, Seoul, Korea. We retrospectively evaluated clinical outcomes at two weeks, one month, three months, and one year after the initiation of intravenous corticosteroid therapy.RESULTS: Our study included a total of 67 eligible patients. At two weeks, 56 (83.6%) patients responded to intravenous corticosteroids. At one month, complete remission was documented in 18 (32.1%) patients and partial remission in 26 (46.4%). Eleven patients (19.7%) were refractory to the treatment. At three months and one year, we found 37 (67.3%) and 25 (46.3%) patients in prolonged response, ten (18.2%) and 23 (42.6%) patients in corticosteroid dependency, and eight (14.5%) and six (11.1%) patients with no response, respectively. The duration of oral corticosteroid therapy (>14 days, p<0.049) and lower hemoglobin level (≤11.0 mg/dl, p<0.02) were found to be poor prognostic factors for response at two weeks.CONCLUSIONS: Our study showed that most Korean patients with active UC responded well to intravenous corticosteroid therapy after oral steroid therapy failure. The duration of oral corticosteroid therapy and lower hemoglobin level were strongly associated with poor outcome.