Effect of Accelerated Infliximab Induction on Short- and Long-term Outcomes of Acute Severe Ulcerative Colitis: A Retrospective Multicenter Study and Meta-analysis

Abstract

In a retrospective study and meta-analysis, we found no association between accelerated infliximab induction therapy and lower rates of colectomy in patients with ASUC, compared to standard induction therapy. However, confounding by disease severity cannot be excluded. Randomized trials are warranted to compare these treatment strategies.

Systematic Review and Meta-analysis: Optimal Salvage Therapy in Acute Severe Ulcerative Colitis

“…(10-12, 14, 20-22, 25-28, 30, 32, 35-47, 49-54, 56-58) Dose intensified induction strategies were employed in eleven studies, (10-12, 14, 20, 22, 32, 49, 56-58) Of these, ten studies utilized an accelerated dosing schedule, (10-12, 20, 22, 32, 49, 56-58) four utilized 10mg/kg dose induction therapy (11,12,14,32) and four studies investigated accelerated induction in conjunction with high dose IFX. (11,12,32,58) One study was a single dose finding RCT (48). One abstract assessed standard versus accelerated schedule induction.…”

Editorial: accelerated infliximab induction—it's time to settle the debate! Authors' reply

“…It is unclear if the potential lack of benefit may be due to provider bias in treatment selection both at patient level and in the dosing and timing of rescue treatment . However, our meta‐analysis and a previous one by Nalagatla et al indicated a trend towards reductions in colectomy rates with an accelerated induction strategy with upfront 10 mg/kg dosing. We attempted to overcome some of the previous limitations with a propensity‐matched analysis and concluded that accelerated dosing was beneficial in reducing short‐term colectomy rates.…”

“…The reality is that, despite the lack of clear trial evidence, the IBD community in the main has already incorporated accelerated induction into their clinical practice based on at least three published national surveys including our own UK survey. [6][7][8] An accelerated dosing strategy has already been recommended in the recently published IBD guidelines of the British Society of Gastroenterology 9 although the American College of Gastroenterology guidelines have suggested this area needs more data before firm recommendations can be made. 10 Our UK survey has identified key parameters to study in this critical area of IBD care and, based on this, we agree with Drs.…”

Letter: should we intensify infliximab in acute severe ulcerative colitis?

“…Available data on accelerated infliximab regimens in ASUC are obtained from few retrospective series conducted in tertiary centres using various outcomes and showing controversial results. Recently, a meta‐analysis based on four studies could not confirm the advantage of an intensified infliximab induction regimen in patients admitted for ASUC . The multicentre retrospective study conducted by Sebastian et al , provides additional information on this pending question.…”