Ciclosporin versus infliximab in patients with severe ulcerative colitis refractory to intravenous steroids: a parallel, open-label randomised controlled trial. - Université Paris Cité Accéder directement au contenu
Article Dans Une Revue The Lancet Année : 2012

Ciclosporin versus infliximab in patients with severe ulcerative colitis refractory to intravenous steroids: a parallel, open-label randomised controlled trial.

Julien Branche
  • Fonction : Auteur
Matthieu Allez
Maria Nachury
  • Fonction : Auteur
Elena Ricart
  • Fonction : Auteur
Olivier Dewit
  • Fonction : Auteur
Antonio Lopez-Sanroman
  • Fonction : Auteur
Franck Carbonnel
  • Fonction : Auteur
  • PersonId : 860464
Gilles Bommelaer
  • Fonction : Auteur
Xavier Roblin
  • Fonction : Auteur
Gert van Assche
  • Fonction : Auteur
Maria Esteve
  • Fonction : Auteur
Martti Färkkilä
  • Fonction : Auteur
Stephane Nahon
  • Fonction : Auteur
Martine de Vos
  • Fonction : Auteur
Denis Franchimont
  • Fonction : Auteur
Non Renseigné
  • Fonction : Auteur

Résumé

BACKGROUND: Ciclosporin and infliximab are potential rescue treatments to avoid colectomy in patients with acute severe ulcerative colitis refractory to intravenous corticosteroids. We compared the efficacy and safety of these drugs for this indication. METHODS: In this parallel, open-label, randomised controlled trial, patients were aged at least 18 years, had an acute severe flare of ulcerative colitis defined by a Lichtiger score greater than 10 points, and had been given an unsuccessful course of high-dose intravenous steroids. None of the patients had previously received ciclosporin or infliximab. Between June 1, 2007, and Aug 31, 2010, patients at 27 European centres were randomly assigned (via computer-derived permutation tables; 1:1) to receive either intravenous ciclosporin (2 mg/kg per day for 1 week, followed by oral drug until day 98) or infliximab (5 mg/kg on days 0, 14, and 42). In both groups, azathioprine was started at day 7 in patients with a clinical response. Neither patients nor investigators were masked to study treatment. The primary efficacy outcome was treatment failure defined by absence of a clinical response at day 7, a relapse between day 7 and day 98, absence of steroid-free remission at day 98, a severe adverse event leading to treatment interruption, colectomy, or death. Analysis was by intention to treat. This trial is registered with EudraCT (2006-005299-42) and ClinicalTrials.gov (NCT00542152). FINDINGS: 115 patients were randomly assigned; 58 patients were allocated to receive ciclosporin and 57 to receive infliximab. Treatment failure occurred in 35 (60%) patients given ciclosporin and 31 (54%) given infliximab (absolute risk difference 6%; 95% CI -7 to 19; p=0*52). Nine (16%) patients in the ciclosporin group and 14 (25%) in the infliximab group had severe adverse events. INTERPRETATION: Ciclosporin was not more effective than infliximab in patients with acute severe ulcerative colitis refractory to intravenous steroids. In clinical practice, treatment choice should be guided by physician and centre experience. FUNDING: Association François Aupetit, Société Nationale Française de Gastroentérologie, and the International Organization for the study of Inflammatory Bowel Disease.

Domaines

Chimie organique

Dates et versions

hal-00742308 , version 1 (16-10-2012)

Identifiants

Citer

David Laharie, Arnaud Bourreille, Julien Branche, Matthieu Allez, Yoram Bouhnik, et al.. Ciclosporin versus infliximab in patients with severe ulcerative colitis refractory to intravenous steroids: a parallel, open-label randomised controlled trial.. The Lancet, 2012, 380 (9857), pp.1909-1915. ⟨10.1016/S0140-6736(12)61084-8⟩. ⟨hal-00742308⟩
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