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Journal Article Discussion :Infliximab versus ciclosporin for steroid-resistant acute severe ulcerative colitis (CONSTRUCT): a mixed methods, open-label, pragmatic randomised trial

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17 Jul 2016 - General
 

Ulcerative colitis is a sub-type of Inflammatory Bowel Disease (IBD), that occur due to inflammation and ulceration of colonic mucosa. Ulcerative colitis will only affect the large bowel / colon. The aetiology of this condition is unknown, but a few factors were speculated that might cause ulcerative colitis. This is a chronic disease. Intravenous steroid is the standard therapy used to manage the acute flare of ulcerative colitis, and usually it is effective to induce remission of disease. But, sometime, acute severe ulcerative colitis may be not responding to steroid therapy, and it require rescue Infliximab treatment (biologic anti-TNF, which is a standard treatment after failure of steroid). Ciclosporin is another option in this scenario. The study above, which was published in The Lancet (Gastroenterology & Hepatology), has showed that there is no different between infliximab and ciclosporin in patients with steroid-resistant acute ulcerative colitis. Would you consider to use ciclosporin in steroid resistant acute severe ulcerative colitis ???? Or we should just use Infliximab ??

Usually, when we use Infliximab as a rescue therapy for the acute flare of Inflammatory Bowel Disease, we need to do some pre-biologic screens (like Hep B, Hep C virus, HIV, and Mantoux test / quantiferon test for latent TB), before giving Infliximab to patient. Infliximab is given by the dose of 5mg/kg at week 0, then at week 2, then at week 6, and will be followed by maintenance regimen of 5mg/kg every 8 weeks. Each infusion will be given over around 2 hours period. We need to inform patient...
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Hi Marinelle, to be honest, nowadays, I would say most of the gastroenterologist will prefer to use Infliximab. Personally, i have always use Infliximab, did not have much experience with cyclosporine treatment. Cyclosporine do has a role to induce remission in patients with refractory colitis. But, it might not be effective or safe for long term use. In addition, cyclosporine will not be an option for the cohort of patient who are not tolerating azathioprine or 6-MP or patient who has failed on...
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Hi You Yi, to be honest I have absolutely no experience in using these medications. However, for purposes of discussion, since both treatments have been proven to be equally safe and effective in refractory cases of acute severe ulcerative colitis, then the selection of medication should be based on the following criteria: 1) Side effect profile, 2) Cost 3) Drug monitoring. Although the side effects of cyclosporine and infliximab are comparable, in theory, since infliximab is a more targeted the...
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