High-Dose Infliximab Rescue Therapy for Hospitalized Acute Severe Ulcerative Colitis Does Not Improve Colectomy-Free Survival

Overview

Journal Dig Dis Sci

Specialty Gastroenterology

Date 2018 Nov 18

PMID 30446928

Citations 13

Authors

Che-Yung Chao

Alex Al Khoury

Achuthan Aruljothy

Sophie Restellini

Jonathan Wyse

Waqqas Afif

Alain Bitton

Peter L Lakatos

Talat Bessissow

Affiliations

Soon will be listed here.

Abstract

Background And Objective: Optimization strategies with infliximab (IFX) are increasingly used as rescue therapy for steroid refractory acute severe ulcerative colitis (ASUC). We aim to determine if intensified IFX induction improves colectomy rate and identifies outcome predictors.

Methods: Hospitalized adult patients who received IFX for ASUC between 2010 and 2016 were identified. We compared standard inductions (5 mg/kg) vs high-dose induction (10 mg/kg) with 3-month colectomy rate as primary outcome.

Results: Seventy-two patients (62.5% male, median age 38.5) were identified. Thirty-seven patients (51.3%) received 5 mg/kg IFX and 35 received 10 mg/kg. Baseline clinical, biochemical and endoscopic parameters were well matched between these two groups. 10 mg/kg was more likely to be used by clinicians from 2014 onwards (p < 0.001). Three-month colectomy rate was 9.7%; which was not significantly different between the standard (5.4%) and high-dose (14.3%) IFX induction (p = 0.205). CRP ≥ 60 (OR 10.9 [95% CI 1.23-96.50], p = 0.032), hemoglobin ≤ 90 g/L (OR 15.6 [95% CI 2.61-92.66], p = 0.036) and albumin < 30 g/L (OR 9.4 [95% CI 1.06-83.13], p = 0.044) were associated with increased risk of colectomy at 3 months in univariate regression analysis.

Conclusion: Use of high-dose infliximab rescue therapy did not improve 3-month colectomy-free survival in this cohort. Tailored use in high-risk patients may be beneficial although further validation is required.

Citing Articles

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Comparison of accelerated and standard infliximab induction regimens in acute severe ulcerative colitis using propensity score analysis: a retrospective multicenter study in China.

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