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

Background and Aims Data on acute severe ulcerative colitis (ASUC) management in patients with prior 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 were 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 < 0.001), but clinical response rates were similar. Rescue therapy rates were comparable (52% vs 57%, p = 0.88); infliximab use was lower in cohort 1 (25% vs 54%, p < 0.01). At 12 months, cohort 1 showed lower remission (44% vs 59%, p = 0.03) and higher colectomy (17% vs 8.7%, p = 0.01). Overall colectomy was higher in cohort 1 (34% vs 17%; HR 2.46, p = 0.001). 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.