Infliximab salvage therapy after cyclosporine in an acute flare of chronic ulcerative colitis

Intravenous corticosteroidsIntravenous corticosteroids remain the initial therapy for a severe acute flare of chronic ulcerative colitis (CUC). Therapeutic options for patients who have failed a trial of steroids depend on the clinical scenario and, in part, patient preference. Although colectomy is curative, patients who are not presenting with acute abdominal symptoms requiring surgery may elect to have a trial of medical therapy. Intravenous cyclosporine has been used to induce remission in patients with steroid refractory acute flares. Approximately 18% to 43% of these patients fail to respond to cyclosporine and total proctocolectomy is the only therapeutic option.

Ulcerative colitis and Crohn’s disease are idiopathic inflammatory conditions of the gastrointestinal tract. Differences in their proinflammatory and cytokine profiles have resulted in different emerging therapies for these two conditions. A common proinflammatory mediator early in the cytokine cascade is tumour necrosis factor alpha (TNFa). Infliximab (Remicade, Schering Canada Inc, Quebec) is a chimeric monoclonal antibody against soluble and receptor based TNFa. Its role in Chrohn’s disease has been well established by impressive clinical trials for steroid refractory disease. However, the use of infliximab in cyclosporine refractory CUC is more controversial due to the lack of adequate clinical trials.

There appears to be a rationale for employing the same anti-TNFa strategy in steroid refractory CUC. In the animal model of CUC (cotton-top tamarins), neutralization of soluble TNFa with CDP 571 (a humanized soluble TNFa antibody) resulted in rapid clinical improvement. Limited human studies of anti-TNFa therapy for steroid resistant acute flares of CUC have also been performed. These studies did not include patients treated with cyclosporine before infliximab therapy. We report a case in which infliximab was used as salvage medical therapy in a patient who failed intravenous cyclosporine therapy during an acute flare of CUC. You can finally spend less money and time whenever your need cialis professional canadian pharmacy cialis professional 20 mg since you are being given access to the best online pharmacy you have ever come across.

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