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Systematic review of therapies for refractory ulcerative proctitis.
Raja, Sreecanth S; Bryant, Robert V; Costello, Samuel P; Barnett, Meghan; Schubert, Jonathon; Rayner, Chris K.
Afiliação
  • Raja SS; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
  • Bryant RV; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
  • Costello SP; Department of Gastroenterology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
  • Barnett M; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
  • Schubert J; Department of Gastroenterology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
  • Rayner CK; Department of Gastroenterology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
J Gastroenterol Hepatol ; 38(4): 496-509, 2023 Apr.
Article em En | MEDLINE | ID: mdl-36644922
ABSTRACT
Patients with ulcerative proctitis have favorable long-term outcomes but are typically excluded from ulcerative colitis clinical trials. Refractory proctitis presents a management conundrum for gastroenterologists, and there remains a lack of clarity as to the best therapeutic strategy. This study aimed to undertake a systematic review of studies assessing the clinical efficacy and safety of therapies for refractory proctitis. PubMed, Embase, Cochrane Library, and MEDLINE databases were searched without restriction from inception to October 27, 2022. Both interventional and noninterventional studies examining efficacy of therapeutic modalities for the induction and/or maintenance of remission in refractory proctitis were included. Included studies were grouped by therapeutic modalities as follows (i) immunomodulators, (ii) monoclonal antibodies, (iii) topical calcineurin inhibitors, (iv) other topical therapies, and (v) appendicectomy. The search strategy identified 3301 studies, of which 13 met eligibility criteria for inclusion. Clinical remission rates for systemic therapies ranged from 20-26% for azathioprine to 50-69% for tumor necrosis factor-α inhibitor therapies. The use of systemic therapies for proctitis raised safety concerns, with 22-37% of patients discontinuing therapies due to adverse effects across four retrospective cohort studies. Prospective clinical trials of topically applied tacrolimus demonstrated clinical remission rates of 42-46%, with a favorable safety profile. Substantial heterogeneity in study design precluded meta-analysis. Refractory ulcerative proctitis remains a neglected entity, with a dearth of prospective clinical trials to guide therapeutic decision-making. Current evidence supports a role for topically administered tacrolimus.
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Texto completo: 1 Coleções: 01-internacional Temas: Geral Base de dados: MEDLINE Assunto principal: Proctite / Colite Ulcerativa Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Revista: J Gastroenterol Hepatol Assunto da revista: GASTROENTEROLOGIA Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Austrália

Texto completo: 1 Coleções: 01-internacional Temas: Geral Base de dados: MEDLINE Assunto principal: Proctite / Colite Ulcerativa Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Revista: J Gastroenterol Hepatol Assunto da revista: GASTROENTEROLOGIA Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Austrália