Antunes Pedro Bernardes, Gonçalves Bruno, Arroja Bruno, Gonçalves Raquel, Leal Tiago
Gastroenterology Department, Hospital de Braga, Braga, Portugal.
GE Port J Gastroenterol. 2022 Oct 21;30(5):390-397. doi: 10.1159/000526509. eCollection 2023 Oct.
Acute severe ulcerative colitis (ASUC) is an emergent medical condition and particularly challenging to treat efficaciously. Infliximab is one of the medical salvage treatment options after corticosteroid refractoriness, but the best induction strategy is not yet defined. With this case series, the authors intend to describe three corticosteroid-refractory ASUC cases with different intensified/accelerated infliximab induction approaches and review the literature on this topic. The first case describes an 18-year-old girl with ASUC at disease onset with rapid progression to toxic megacolon, complicated also with anemia, hypoalbuminemia, and coagulopathy. After corticosteroid failure, both accelerated and intensified (10 mg/kg) infliximab regimen was completed within 11 days, with solid clinical response and colon imaging normalization. Second, we present a 26-year-old male with left-sided ulcerative colitis known for 2 years, under mesalazine, who developed a moderate flare and was started on infliximab after partial and inconsistent response to corticosteroids. During the induction period, he presented this time an ASUC episode, which motivated an early and intensified third dose with good clinical response. Finally, we describe the case of a 78-year-old man with ulcerative proctitis for 12 years presenting ASUC with proximal disease extension as well. After unsatisfactory response to corticosteroids, infliximab was initiated on an accelerated induction regimen, completed in 13 days, with the standard dose, achieving clinical remission. Accelerated or intensified infliximab induction plans are becoming current clinical practice in corticosteroid-refractory ASUC. Current guidelines refer to the possibility of this type of strategies, not determining the optimal regimen due to lack of solid evidence. Literature is mainly based on retrospective studies, not randomized, with heterogeneous groups according to disease severity, and the effect on colectomy rates, mainly on the long term, is not clear. Additional well-supported studies are needed on this subject in order to seek a more widely uniform approach.
急性重症溃疡性结肠炎（ASUC）是一种紧急医疗状况，有效治疗极具挑战性。英夫利昔单抗是皮质类固醇难治性疾病后的挽救治疗选择之一，但最佳诱导策略尚未明确。通过本病例系列，作者旨在描述三例皮质类固醇难治性ASUC病例，采用不同的强化/加速英夫利昔单抗诱导方法，并回顾该主题的文献。第一例描述了一名18岁患有ASUC的女孩，疾病起病时迅速进展为中毒性巨结肠，还并发贫血、低白蛋白血症和凝血病。皮质类固醇治疗失败后，在11天内完成了加速和强化（10mg/kg）英夫利昔单抗方案，临床反应良好，结肠影像学恢复正常。第二例，我们介绍一名26岁左侧溃疡性结肠炎男性，患病2年，服用美沙拉嗪，出现中度发作，对皮质类固醇部分反应且不一致后开始使用英夫利昔单抗。在诱导期，他此次出现ASUC发作，促使早期强化使用第三剂，临床反应良好。最后，我们描述一名78岁患有溃疡性直肠炎12年的男性病例，也出现ASUC且疾病向近端扩展。对皮质类固醇反应不佳后，开始使用加速诱导方案的英夫利昔单抗，13天内完成标准剂量治疗，实现临床缓解。加速或强化英夫利昔单抗诱导方案正成为皮质类固醇难治性ASUC的当前临床实践。当前指南提及了这类策略的可能性，但由于缺乏确凿证据未确定最佳方案。文献主要基于回顾性研究，未进行随机分组，根据疾病严重程度分组各异，对结肠切除率的影响，主要是长期影响，尚不清楚。关于该主题需要更多有力支持的研究，以寻求更广泛统一的方法。
