Predictive factors of response to intravenous ciclosporin in severe ulcerative colitis: the development of a novel prediction formula.

Abstract

BACKGROUND:

When treating patients with severe ulcerative colitis (UC), accurate prediction of drug efficacy contributes to early clinical decision-making.

AIM:

To identify predictive factors and to develop a reliable prediction formula and a decision tree of response to intravenous ciclosporin treatment for severe UC.

METHODS:

Patients included in this study were those diagnosed with refractory severe UC who had undergone ciclosporin treatment between December 2004 and March 2011 at a tertiary referral centre in Japan. Demographic and clinical parameters from all patients were analysed by multivariate statistics.

RESULTS:

Fifty-two patients were included in this study (36.5% men with an average age of ciclosporin initiation of 40.2 ± 15.6 years). Thirty-four patients (65.4%) were responders to the treatment with ciclosporin and avoided colectomy, 18 patients (34.6%) were nonresponders and underwent colectomy. Stepwise multiple logistic regression analysis identified four independent predictive factors of response to intravenous ciclosporin: age at hospitalisation (AGE), platelet count (×10(4) /μL) on the first day (PLA), Lichtiger score on the third day (LIC) and total protein (g/dL) on the third day minus total protein on the first day (ΔTP). The calculation formula (8.5 - 0.16 × AGE + 0.21 × PLA - 0.61 × LIC + 2.3 × ΔTP < 0) predicted colectomy with an accuracy of 88.5% and the decision tree predicted colectomy with an accuracy of 90.4%.

CONCLUSION:

The novel calculation formula and the decision tree effectively predict the clinical outcome of ciclosporin treatment for severe ulcerative colitis as early as on day 3 after starting ciclosporin treatment.

• Authors: K Saito, T Katsuno, T Nakagawa, M Saito, S Sazuka, T Sato, T Matsumura, M Arai, H Miyauchi, H Matsubara, O Yokosuka
• Journal: Alimentary pharmacology & therapeutics (Aliment Pharmacol Ther) Vol. 36 Issue 8 Pg. 744-54 (Oct 2012) ISSN: 1365-2036 [Electronic] England
• PMID: 22957944 (Publication Type: Journal Article)
• Copyright: © 2012 Blackwell Publishing Ltd.

Chemical References

• Immunosuppressive Agents
• Cyclosporine

Topics

• Administration, Intravenous
• Adolescent
• Adult
• Aged
• Colitis, Ulcerative (drug therapy)
• Cyclosporine (administration & dosage)
• Female
• Humans
• Immunosuppressive Agents (administration & dosage)
• Male
• Middle Aged
• Predictive Value of Tests
• Severity of Illness Index
• Treatment Outcome
• Young Adult