Therapeutic management and risk of colectomy in patients with acute severe ulcerative colitis and previous exposure to anti-tumor necrosis factor drugs: a comparative study of GETECCU

BACKGROUND AND AIMS: Data on the management of acute severe ulcerative colitis (ASUC) in patients with prior anti-tumor necrosis factor (anti-TNF) exposure are limited. We compared medical management, colectomy risk, and mortality between anti-TNF-exposed and bio-naive patients. METHODS: This retrospective, multicenter GETECCU study included two ASUC cohorts (2010-2020): anti-TNF-exposed (cohort 1) and bio-naive (cohort 2). Patients previously treated with other advanced therapies were excluded. Steroid response was defined by reduced bowel movements and C-reactive protein. Rescue therapies were used for steroid failure. Maintenance therapy was initiated post-ASUC. Clinical effectiveness was assessed using the partial Mayo score (remission ≤2). Colectomy rates were analyzed through survival analysis and Cox regression. Mortality at 12 months was also evaluated. RESULTS: A total of 461 patients were included: 149 in cohort 1 and 312 in cohort 2. Steroid use was lower in cohort 1 (82% vs 97%, P < .001), but clinical response rates were similar. Rescue therapy rates were comparable (52% vs 57%, P = .88); infliximab use was lower in cohort 1 (25% vs 54%, P < .01). At 12 months, cohort 1 showed lower remission (44% vs 59%, P = .03) and higher colectomy (17% vs 8.7%, P = .01). Overall colectomy was higher in cohort 1 (34% vs 17%; hazard ratio 2.46, P = .001). One-year mortality was 1.52% (no significant differences between cohorts). CONCLUSION: ASUC management in anti-TNF-exposed patients is heterogeneous and differs from that of bio-naive patients, with increased risk of treatment failure and colectomy.