[Maintenance therapy by azathioprine after successful treatment by intravenous corticosteroid in acute severe colitis. An open prospective study]

To investigate the efficacy of azathioprine as maintenance therapy in acute severe colitis of Crohn's disease or ulcerative colitis after successful treatment by intravenous corticosteroids. We conduct an open prospective study between 1999 and 2004. All patients with acute severe colitis and good Outcome after seven at ten days of intravenous corticosteroid treatment received azathioprine [2-2.5 mg/kg/day]. Rates of relapse, severe relapse and recurrence of acute severe colitis were studied and compared to patients treated between 1990 and 1998 with no azathioprine therapy after remission induced by intravenous corticosteroids. Between 1999 and 2004, 21 patients with acute severe colitis and favourable outcome with intravenous corticosteroid therapy received azathioprine with a mean follow-up of 26 months. Comparatively to the 22 patients with no azathioprine therapy, the rate of relapse was lower in azathioprine group [10% vs 55%; p=0.002] as well as rate of severe relapse [0% vs 36%; p=0.002] and recurrence of acute severe colitis [0% vs 27%; p=0.01]. In univariate analysis, predictive factors of relapses were absence of azathioprine therapy [p= 0.002 OR [IC 95%]: ll.4 [2.12-61.25]], absence of decrease of levels of. ESR the 3[rd] day of treatment [p=0.004 OR [IC 95%]: 10.0 [1.79-55.63]] and absence of sigmoid involving [p=0.03 OR [IC 95%]: 4.80 [1.15-19.92]]. In multivariate analysis, the independent predictive factor of relapse was absence of azathioprine therapy [p=0.003 adjusted OR [IC 95%]: 2.17 [1.44-6.66]]. The only predictive factor of severe relapse was also absence of azathioprine therapy [p=0.002 OR [IC 95%]: 2.5 [1.66-3.84]]. Maintenance therapy with azathioprine is effective in prevention of relapses in patients with acute severe colitis and favourable outcome with intravenous corticosteroid therapy

[Predictive factors of failure of intravenous corticoid treatment in acute severe colitis of Crohn's disease and Ulcerative Colitis]

We conducted a retrospective study on 78 cases of acute severe colitis [Crohn's disease in Si cases, ulcerative colitis in 27 cases]. Diagnosis of acute severe colitis was based on presence of Truelove's criteria and/or endoscopical gravity lesions. Failure of corticoid treat-ment was observed in 35 patients [45%]. In overall patients, predic-tive factors of failure of intravenous corticoid treatment in univariate analysis are diagnosis of ulcerative colitis, number of bloody stool higher than 6/day. level of C-reactive protein lower than 25 mg/I. visibility of muscular mucosa at colonoscopy, absence of decrease in erythrocyte-sedimentation rate for more than 50% of initial value at day 3 of treatment, absence of decrease in C-reactive protein for more than 50% of initial value at day 3 of treatment, and a lower duration of corticoid treatment. In multivariate analysis. independent predictive factors of failure of corticoid treatment are a number of bloody stool higher than 6/day [p=0.01 adjusted OR [CI95%]: 10.2 [1.15 - 72.06]] and a value of initial C-reactive protein lower than 25 mg/I [p < 0.0001 adjusted OR [CI95%]: 3.25 [2.95 - 4.31]]. In Crohn's disease, the only independent predictive factor of failure of corticoid treatment is an absence of decrease of C-reactive protein level for more than 50% of initial value at day 3 of treatment [p = 0.001 adjusted OR [C195%]: 0.79 [0.45-0.95]]. Existence of these predictive factors allows the early identification of patients who would be suitable for second-line therapy