Inflammatory Bowel Disease Clinical

Abstract

Introduction: Recent evidence has indicated that an accelerated infliximab dosing regimen may reduce early colectomy rates in patients with acute severe ulcerative colitis (ASUC). However, there are limited data on rates of mucosal healing in those who receive accelerated regimens compared with standard dosing. Achieving mucosal healing has been unequivocally associated with better clinical outcomes. Aim: To determine whether accelerated infliximab induction achieves higher rates of endoscopic mucosal healing than standard induction, and consequently reduces the need for early colectomy in patients with ASUC. Methods: We prospectively collected data on hospitalized patients who received infliximab for steroid-refractory ASUC at a large, metropolitan teaching hospital inflammatory bowel disease (IBD) unit from January 2014 to December 2016. Patients received standard dosing (SD) or accelerated dosing (AD) at the discretion of one of two treating IBD physicians. In this retrospective study, we analyzed patients with at least 6 months of follow-up. We compared outcomes of dosing regimens. Clinical data collected on admission, at induction, and 3 months and 6 months after infusion were analyzed. Endoscopic data and rates of colectomy were compared between the groups during induction and follow-up periods until May 2017 (median follow up period of 12 months). Mucosal healing was defined as a Mayo endoscopic sub-score ≤ 1. Results: We analyzed the outcome in 44 hospitalized patients with steroidrefractory ASUC who received infliximab induction therapy. Overall, 27 were male (61%), with a mean age of 33 years (IQR,. Median disease duration was 1 year (IQR, 0-5.5 years), and 14 patients (32%) were on immunomodulators at admission. Sixteen patients received SD over an induction period of 6 weeks, and 28 received AD over a median duration of 18 days (IQR, 2-35 days). Patients receiving AD had a higher proportion of severe baseline endoscopic findings (Mayo endoscopic subscore, 3) compared with SD (57% vs 38%), and higher C-reactive protein (CRP) levels at admission (113 ± 89.3 vs 69.4 ± 69.6). At 6 months' follow-up, mucosal healing was achieved in 18 patients (64%) in the AD group compared with 7 patients (44%) for SD. Median time to mucosal healing was 68 days (IQR,. Those who achieved mucosal healing maintained mucosal healing at long-term follow-up endoscopy. The colectomy rate was similar in AD and SD groups (21% vs 19%) over the follow-up period. Median time to colectomy was 46 days (IQR, 2-365 days). Factors associated with poor mucosal healing at 6 months were high induction CRP (t, -2.26, P = 0.033) and CRP:albumin ratio (t, -2.20, P = 0.034). The administration of triple combination therapy (infliximab, immunomodulators, and aminosalicylates) was associated with both maintaining long-term mucosal healing (odds ratio [OR], 0.31; P = 0.065) and reducing colectomy rate (OR, 0.24; P = 0.089). Conclusions: In this preliminary study of patients with ASUC, accelerated infliximab induction was found to be safe and effec...

Comparable Long-Term Outcomes of Cyclosporine and Infliximab in Patients With Steroid-Refractory Acute Severe Ulcerative Colitis: A Meta-Analysis

“…After the removal of duplicates, 594 records remained, 565 of which were excluded by titles and abstracts. The remaining 29 articles were assessed for eligibility by full-text and further 10 studies were excluded due to the following reasons: three studies reported only short-term follow-up data (39-41), one study did not report on the timing and rate of colectomy (38) and two studies were uncontrolled (42,43). In two studies, the number of patients treated with CYS and IFX was not reported (44,45), one study included patients pre-treated with either CYS or IFX (46) and one study evaluated patients with Crohn's colitis (47).…”