HOW EFFECTIVE IS CURRENT MEDICAL THERAPY FOR SEVERE ULCERATIVE AND CROHNS COLITIS - AN ANALYTIC REVIEW OF SELECTED TRIALS

To determine the efficacy of current medical therapies in the treatmen t of severe ulcerative and Crohn's colitis, we conducted a MEDLINE com puter-assisted literature search using the terms ''severe ulcerative c olitis,'' ''severe Crohn's colitis,'' ''drugs,'' and ''therapy'' Studi es were compared and then selected based, in decreasing order of impor tance, on the use of standard criteria to assess disease severity, uni form entrance criteria with prospective drug protocols using defined e nd points; prospective placebo-controlled trials; and retrospective st udies. We then conducted an analytic review of those studies selected. For severe ulcerative colitis, we identified seven studies comprising 319 treatment episodes in 306 patients. Clinical remission was achiev ed on average in 62% of subjects (range, 43-80%); 38% (25-57%) came to prompt colectomy. Remission was maintained in 38-71% of patients achi eving success in the acute phase. For severe Crohn's colitis, we ident ified five studies comprising 68 patients. Clinical remission was achi eved on average in 65% of patients (range, 55-94%). Remission was main tained in 54-69% of those achieving success in the acute phase. Curren t medical therapies have improved the outlook for severe ulcerative co litis; however, physicians cannot predict response to therapy based up on individual's clinical features or previous presentations. Current m edical therapy for severe Crohn's colitis appears to spare many patien ts early colectomy, but the current dearth of clinical trials postpone s any further advances in the medical management of these patients.