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REVISAN LAS POSIBLES CONDUCTAS FRENTE A LA COLITIS ULCEROSA REFRACTARIA A ESTEROIDES

(especial para SIIC © Derechos reservados)
Aun no está claro cuál es el mejor tratamiento para la colitis ulcerativa refractaria a esteroides. Las opciones actuales incluyen ciclosporina, infliximab y colectomía. El propósito de este trabajo es revisar, a partir de los ensayos clínicos publicados, las opciones terapéuticas para los pacientes con colitis ulcerativa grave refractaria a esteroides.
moss9.jpg Autor:
Alan Moss
Columnista Experto de SIIC

Institución:
Harvard Medical School

Artículos publicados por Alan Moss
Recepción del artículo
24 de Mayo, 2010 		Aprobación
6 de Octubre, 2010
Primera edición
28 de Febrero, 2011 		Segunda edición, ampliada y corregida
7 de Junio, 2021

REVISAN LAS POSIBLES CONDUCTAS FRENTE A LA COLITIS ULCEROSA REFRACTARIA A ESTEROIDES

Resumen
Aproximadamente el 15% de los pacientes con colitis ulcerosa (CU) presentará algún episodio grave que requiera internación. Si bien los esteroides intravenosos son el tratamiento de primera elección en estos pacientes, alrededor del 30% no responderá a esta conducta, y necesitará un agente antiinflamatorio alternativo o cirugía. En este contexto, la ciclosporina demostró su eficacia en una cantidad importante de estudios controlados, y se caracteriza por lograr altas tasas de respuesta temprana. Los pacientes que responden a la ciclosporina y evitan la colectomía tienen más probabilidades de conservar el colon si son tratados con inmunomoduladores a mediano plazo. El infliximab también demostró su eficacia para reducir la frecuencia de colectomías tempranas, y se aguardan los resultados en el largo plazo. Otras posibles alternativas, como visilizumab, tacrolimus, basiliximab y leucocitoaféresis, se evaluaron en estudios pequeños y abiertos, donde demostraron también su eficacia. Los temas clave que persisten son determinar los tratamientos de primera y segunda línea, definir el momento de la cirugía y el riesgo de la superposición de inmunosupresores en los pacientes con colitis grave.

Palabras clave
colitis ulcerosa, esteroides, infliximab, ciclosporina, colectomía


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Therapeutic Options for Steroid-Refractory Severe Ulcerative Colitis: A Systematic Review

Abstract
Approximately 15% of patients with ulcerative colitis will experience a severe episode requiring hospitalization. Although intravenous steroids are the current first-line therapy for these patients, about 30% of patients do not respond to steroids, and require either an alternative anti-inflammatory agent or surgery. Cyclosporine has proven its efficacy in a number of controlled trials in this setting, and is characterized by high early response rates. Patients that respond to cyclosporine and avoid colectomy are more likely to retain their colon if they bridge to immunomodulators in the medium-term. Infliximab has also demonstrated efficacy in reducing early colectomy rates, and longer term data are awaited. Other agents such as visilizumab, tacrolimus, basiliximab, and leukocytaphereis have been studied in small or open-labeled trials, and may be alternative options. Key issues remain as to what should be first and second line therapies, when surgery should be undertaken, and the risk of overlapping immuno-suppressants in patients with severe colitis.

Key words
ulcerative colitis, steroids, infliximab, cyclosporine, colectomy


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Clasificación en siicsalud
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Especialidades
Principal: Gastroenterología, Medicina Interna
Relacionadas: Anatomía Patológica, Cirugía, Diagnóstico por Imágenes, Diagnóstico por Laboratorio, Farmacología



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Enviar correspondencia a:
Alan Moss, Harvard Medical School Beth Israel Deaconess Medical Center, MA 02215, Rose 1 / East, 330 Brooklien Ave, Boston, EE.UU.
Patrocinio y reconocimiento:
No declarado.
Bibliografía del artículo


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