Long-Term Outcomes of Immunosuppression-Naive Steroid Responders Following Hospitalization for Ulcerative Colitis

BackgroundRequirement for hospitalization in ulcerative colitis (UC) is a marker of severity of disease. However, the paradigm of when to escalate therapy in such patients and the benefits of early immunomodulator initiation is less well established.AimTo examine the benefits of early therapy escalation in immunosuppression-naive patients hospitalized with severe ulcerative colitis responsive to steroids.MethodsWe identified hospitalized UC patients who were immunosuppression naive at index hospitalization and responded to intravenous steroids, not requiring medical or surgical rescue therapy. The therapy escalated' group comprised of those who were initiated on immunomodulators within 3months of hospitalization. The need for colectomy at 12months was compared to the not escalated' group who remained on non-immunosuppressive therapy.ResultsAmong 133 immunosuppressive naive patients hospitalized for ulcerative colitis, 13 (9.8%) who responded to intravenous steroids and did not require rescue therapy underwent colectomy by 1year. Among 123 patients who escalated to either immunomodulators (n=46, 37%) or remained on non-immunosuppressive therapy (92% on 5-ASA), there was no difference in the need for colectomy at 1year (10.8 vs. 7.8%; multivariate OR 1.29, 95% CI 0.35-4.74). There was also no difference in the time to colectomy between the two groups (p=0.55).ConclusionImmunosuppression-naive ASUC patients who respond to intravenous steroids remain at risk for colectomy. Immunomodulator initiation by 3months did not reduce risk of colectomy at 1year. There is an important need for prospective studies identifying thresholds for therapy escalation in UC.