RESUMEN
BACKGROUND: The long-term efficacy of adalimumab in patients with ulcerative colitis is not well known. AIM: To evaluate the short- and long-term outcomes of adalimumab in ulcerative colitis patients previously treated with infliximab. METHODS: Patients with active ulcerative colitis were treated with adalimumab after failure of other therapies including infliximab. Short-term clinical response and remission were assessed at weeks 4 and 12. The proportion of patients who continued on adalimumab and the proportion of patients who remained colectomy free were assessed over the long term. RESULTS: Clinical response at weeks 4 and 12 was achieved in 16 (53%) and 18 (60%) patients, respectively, and clinical remission was obtained in 3 (10%) and 8 (27%) patients, respectively. After a mean 48 weeks' follow-up, 15 patients (50%) continued on adalimumab. Six patients (20%) required colectomy. All patients who achieved clinical response at week 12 were colectomy free at long term. CONCLUSIONS: Adalimumab was well tolerated and induced durable clinical response in many patients with otherwise medically refractory ulcerative colitis. Patients achieving clinical response at week 12 avoided colectomy over the long term.
Asunto(s)
Antiinflamatorios/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Colitis Ulcerosa/tratamiento farmacológico , Adalimumab , Adulto , Anticuerpos Monoclonales Humanizados , Colectomía , Colitis Ulcerosa/cirugía , Femenino , Humanos , Infliximab , Masculino , Persona de Mediana Edad , Análisis de Regresión , Retratamiento , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Antivirales/efectos adversos , Hepatitis C Crónica/tratamiento farmacológico , Interferón-alfa/efectos adversos , Piel/patología , Adulto , Antivirales/administración & dosificación , Antivirales/uso terapéutico , Biopsia , Humanos , Inyecciones/efectos adversos , Interferón alfa-2 , Interferón-alfa/administración & dosificación , Interferón-alfa/uso terapéutico , Masculino , Necrosis , Proteínas Recombinantes , Ribavirina/administración & dosificación , Ribavirina/uso terapéuticoAsunto(s)
Camellia sinensis/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Orthosiphon/efectos adversos , Hojas de la Planta/efectos adversos , Preparaciones de Plantas/efectos adversos , Té/efectos adversos , Administración Oral , Adulto , Enfermedad Hepática Inducida por Sustancias y Drogas/terapia , Femenino , Humanos , Preparaciones de Plantas/administración & dosificación , Resultado del TratamientoRESUMEN
Multiple hematological anomalies have been described in association with chronic inflammatory bowel disease. Idiopathic thrombocytopenic purpura is an autoimmune disease characterized by the presence of isolated thrombopenia with a normal or increased number of megakaryocytes in bone marrow and absence of splenomegaly. Several case reports of idiopathic thrombocytopenic purpura associated with chronic inflammatory bowel disease, mostly ulcerative colitis, have been published in the literature. The pathogenic mechanism through which these entities are associated is unknown. Several treatments have been used, varying from short courses of steroids to the use of immunosuppressive agents and splenectomy, depending on the severity of the symptoms. We describe the case of a woman with ulcerative colitis and idiopathic thrombocytopenic purpura, in which the latter first presented when the patient was undergoing treatment with corticosteroids and cyclosporin, one of the therapeutic options for controlling thrombopenic purpura. Platelet deficiency persisted despite treatment with azathioprine and colectomy, also described as a possible curative treatment.
