Outcomes of rescue therapy in acute severe ulcerative colitis: data from the United Kingdom inflammatory bowel disease audit

BackgroundApproximately one third of patients with acute severe ulcerative colitis (ASUC) fail response to steroids. Ciclosporin and anti-TNF are proven second-line therapies, but evidence of their efficacy has come mainly from tertiary centres and/or selective clinical trial recruitment. AimTo assess ASUC outcomes in a large unselected cohort. MethodsUK-wide audits of IBD care were conducted in 2008 (209 hospital sites) and 2010 (198 hospital sites), covering >87% of admitting hospitals. Each site entered data from 20 consecutive UC admissions onto a web-based proforma. Admissions included 852 (2008) and 984 (2010) with ASUC, accounting for 35% and 39% of UC admissions, respectively. ResultsASUC in-hospital mortality was 1.2% in 2008; 0.7% in 2010 (P=0.22). Response to first-line steroid therapy was 61% (2008); 58% (2010) and mortality was higher in non-responders: 2008: 2.9% (9/315) vs. 0.19% (1/537; P<0.001); 2010: 1.8% (7/391) vs. 0.0% (0/593; P=0.002). In 2010, more patients (56%) received second-line medical therapy than in 2008 (47%, P=0.02). In-hospital mortality was similar to second-line medical therapy vs. surgery without further medical therapy; 2008: 2.7% vs. 2.8%, P=0.99; 2010: 0.9% vs. 3.1%, P=0.17. Second-line therapy response was more frequently observed with anti-TNF than ciclosporin: (2008: 76% vs. 46%, P<0.001; 2010: 80% vs. 58%, P<0.001). ConclusionsMortality in acute severe ulcerative colitis was low, but higher in steroid non-responders. Patients treated with second-line medical therapies had no higher risk of in-hospital mortality than those undergoing surgery. Second-line rescue' medical therapy usage is increasing; however, ciclosporin response rates were relatively low.