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Clinical outcomes and predictive factors in oral corticosteroid-refractory active ulcerative colitis

 Han Ho Jeon  ;  Hyun Jung Lee  ;  Hui Won Jang  ;  Jin Young Yoon  ;  Yoon Suk Jung  ;  Soo Jung Park  ;  Sung Pil Hong  ;  Tae Il Kim  ;  Won Ho Kim  ;  Jae Hee Cheon 
 WORLD JOURNAL OF GASTROENTEROLOGY, Vol.19(2) : 265-273, 2013 
Journal Title
Issue Date
Administration, Intravenous ; Administration, Oral ; Adolescent ; Adrenal Cortex Hormones/administration & dosage* ; Adrenal Cortex Hormones/therapeutic use* ; Adult ; Aged ; Colitis, Ulcerative/diagnosis* ; Colitis, Ulcerative/drug therapy* ; Colitis, Ulcerative/metabolism ; Dose-Response Relationship, Drug ; Drug Resistance* ; Female ; Follow-Up Studies ; Hemoglobins/metabolism ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Time Factors ; Treatment Failure ; Treatment Outcome ; Young Adult
Clinical outcome ; Corticosteroid ; Prognosis ; Ulcerative colitis
AIM: To evaluate the clinical outcomes and prognostic factors after intravenous corticosteroids following oral corticosteroid failure in active ulcerative colitis patients. METHODS: Consecutive patients with moderate to severe ulcerative colitis 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, South Korea. The disease activity was measured by the Mayo score, which consists of stool frequency, rectal bleeding, mucosal appearance at flexible sigmoidoscopy, and Physician Global Assessment. We retrospectively evaluated clinical outcomes at two weeks, one month, three months, and one year after the initiation of intravenous corticosteroid therapy. Two weeks outcomes were classified as responders or non-responders. One month, three month and one year outcomes were classified into prolonged response, steroid dependency, and refractoriness. 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, 8 (14.5%) and 6 (11.1%) patients with no response, respectively. Total 9 patients were underwent elective proctocolectomy within 1 year. The duration of oral corticosteroid therapy (> 14 d vs ≤ 14 d, P = 0.049) and lower hemoglobin level (≤ 11.0 mg/dL vs >11.0 mg/dL, P = 0.02) were found to be poor prognostic factors for response at two weeks. For one year outcome, univariate analysis revealed that only a partial Mayo score (≥ 6 vs <6, P = 0.057) was found to be associated with a poor response. CONCLUSION: The duration of oral corticosteroid therapy and lower hemoglobin level were strongly associated with poor outcome.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
7. Others (기타) > Dept. of Health Promotion (건강의학과) > 1. Journal Papers
Yonsei Authors
Kim, Won Ho(김원호) ORCID logo https://orcid.org/0000-0002-5682-9972
Kim, Tae Il(김태일) ORCID logo https://orcid.org/0000-0003-4807-890X
Park, Soo Jung(박수정)
Lee, Hyun Jung(이현정)
Jang, Hui Won(장희원)
Jeon, Han Ho(전한호)
Jung, Yoon Suk(정윤숙)
Cheon, Jae Hee(천재희) ORCID logo https://orcid.org/0000-0002-2282-8904
Hong, Sung Pil(홍성필)
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