Long-term outcome of patients with acute severe ulcerative colitis responding to intravenous steroids

Background The long-term outcome of patients with acute severe ulcerative colitis (ASUC) responding to intravenous steroids (IVS) has been poorly reported. Aims To assess relapse-free survival in patients with ASUC responding to IVS. Methods Between January 2006 and December 2017, 142 consecutive patients with ASUC (according to modified Truelove-and-Witts criteria) responding to IVS were included in this multicentre retrospective study. Relapse was defined by a partial Mayo Clinic score >4 and/or the need for another maintenance therapy. Results Among the 142 included patients (100 naive of immunomodulator and/or biological agent) hospitalised for ASUC, 59 (41.5%) were treated at discharge with 5-aminosalicylic acid, 60 (42%) with immunomodulators, 18 (13%) with anti-tumour necrosis factor (TNF) agents and 5 (3.5%) with vedolizumab. After a median follow-up of 4.8 (2.6-7.3) years, 90 (63.4%) had relapsed and 12 (8.5%) had required colectomy. The probabilities of relapse-free survival were 58%, 48% and 40% at 1, 2 and 5 years respectively. The multivariate analysis demonstrated that patients with <6 liquid stools per day at day 3 (hazard ratio 0.56, 95%CI [0.34-0.91]), a partial Mayo Clinic score <2 at day 5 (0.41 [0.21-0.80]) and anti-TNF maintenance therapy (0.37 [0.16-0.87]) were less likely to relapse. The probabilities of colectomy-free survival were 96%, 95% and 91% at 1, 2 and 5 years respectively. Conclusion Despite a high relapse rate, patients with ASUC responding to IVS had a low rate of colectomy after 5 years of follow-up. Early response to IVS and maintenance therapy with biological agents were associated with a lower rate of relapse.