Long‐term outcomes and predictive factors of hospitalized patients with severe ulcerative colitis treated with intravenous corticosteroids

Abstract

Background and Aims: Treatment with intravenous corticosteroids (IVCS) is a mainstay in the management of acute severe ulcerative colitis (UC). Although most patients respond to IVCS, little is known about the long‐term outcomes. In this study, we assessed the long‐term outcomes of IVCS in a real‐life cohort. Methods: Disease activity, clinical relapse (partial Mayo score >4), the need for steroids or other maintenance therapies and the rates of colectomy and re‐hospitalization were evaluated in consecutive patients admitted to the Tor Vergata University hospital between 2010 and 2020 for acute severe UC who responded to IVCS. Results: Eighty‐eight patients were followed up with for a median period of 46 (range 6–133) months. Of these, 56 (64%) patients were treated with 5‐aminosalycilic acid and 32 (36%) with immunomodulators or biologics after discharge. A total of 60 out of 88 patients (68%) relapsed, 28 (32%) were re‐hospitalized, and 15 (17%) underwent a colectomy with no difference between the two maintenance therapy groups. The multivariate analysis showed that patients in clinical remission 6 months after discharge had a lower risk of relapse during the follow‐up. Conclusions: Nearly two‐thirds of patients with acute UC responding to IVCS experienced relapse after a median follow‐up of 4 years, and this was not influenced by the maintenance therapy.