Background: One third of children admitted with acute severe colitis (ASC) fail intravenous corticosteroids (IVCS) and require salvage therapy. Cyclosporine and then tacrolimus (Cys/Tac) have been introduced since 1996, followed by infliximab (IFX) in 2004. However, no data to date have shown whether these interventions actually managed to reduce colectomy rates.
Aim & Methods: We aimed to explore trends in colectomy rate in pediatric ASC using the largest pediatric cohort of ASC to date. 283 children treated with IVCS for ASC during 1990-2012 were included (from the prospective and retrospective OSCI studies, Jerusalem and Liverpool). Patients were followed for 1 year (46% males, age 12.1±3.9 years). Colectomy rates were compared between 3 periods: 1990-1996 (era1: pre medications; n=68), 1997-2004 (era2: Cys/Tac; n=45), 2005-2012 (era3: IFX, Cys/Tac; n=170).
Results: Total 1-year colectomy rates were 40/68 (59%) during era1, 17/45 (38%) during era2, and 31/170 (18%) during era3 (P<0.001). 89 children (31%) failed IVCS treatment and required second line therapy during admission. The 3 era groups were similar in 12 pre-treatment basic variables at admission except for age and ESR. The rate of colectomy in those requiring salvage therapy during the admission was significantly reduced from 100% (51/51) in era 1, to 62% (8/13) in era2 and 33% (14/42) in era3 (p<0.001). Similar trends were seen at 1 year follow up.
Conclusion: We show for the first time that the introduction of Cys/Tac and then infliximab sharply reduced the need for colectomy during admission and 1-year thereafter in pediatric ASC.
