Abstract
Accelerated induction regimens of infliximab have been proposed to improve response rates in patients with steroid-refractory acute severe colitis. To determine the differences in outcome for acute severe ulcerative colitis between accelerated and standard-dose infliximab METHODS: We collected data on hospitalised patients receiving differing regimens of rescue therapy for steroid-refractory acute severe ulcerative colitis. Our primary outcome was 30-day colectomy rate. Secondary outcomes were colectomy within index admission, and at 90days and 12months. We used propensity score analysis with optimal calliper matching using high risk covariates defined a priori to reduce potential provider selection bias. We included 131 patients receiving infliximab rescue therapy; 102 received standard induction and 29 received accelerated induction. In the unmatched cohort, there was no difference by type of induction in the 30-day colectomy rates (18% vs 20%, P=.45), colectomy during index admission (13% vs 20%, P=.26) or overall colectomy (20% vs 24%, P=.38). In the propensity score-matched cohort of 52 patients, 30-day colectomy (57% vs 27%, P=.048) and index admission colectomy (53% vs 23%, P=.045) rates were higher in those receiving standard induction compared to accelerated induction but there was no difference in overall colectomy rates (57% vs 31%, P=.09). There was no significant difference in length of stay or in complication and infection rates. In a propensity score-matched cohort, steroid-refractory acute severe ulcerative colitis patients, short-term, but not long-term, colectomy rates appear to be lower in those receiving an accelerated induction regimen.
Highlights
Acute severe ulcerative colitis is a medical emergency with up to 30% of patients requiring colectomy during their index admission[1,2] and is associated with a mortality of up to 2.9% in peripheral centres and about 1% in specialist inflammatory bowel disease (IBD) units [3]
In the propensity score-matched cohort of 52 patients, 30-day colectomy (57% vs. 27%, p = 0.048) and index admission colectomy (53% vs. 23%,p =0.045) rates were higher in those receiving standard induction compared to accelerated induction but there was no difference in overall colectomy rates between the 2 groups (57% vs. 31%, p =0.09)
In a propensity score matched cohort, steroid refractory Acute Severe Ulcerative Colitis patients, short-term, but not long-term, colectomy rates appear to be lower in those receiving accelerated induction regimen
Summary
Acute severe ulcerative colitis is a medical emergency with up to 30% of patients requiring colectomy during their index admission[1,2] and is associated with a mortality of up to 2.9% in peripheral centres and about 1% in specialist inflammatory bowel disease (IBD) units [3]. Intravenous corticosteroids remain the cornerstone of first-line therapy for acute severe ulcerative colitis. A meta-analysis of cohort studies and randomized trials, published in 2007, examined response to corticosteroids in acute severe ulcerative colitis. Accelerated induction regimens of infliximab have been proposed to improve response rates in patients with steroid refractory acute severe colitis. Aims We aimed to determine differences in outcome for acute severe ulcerative colitis between accelerated and standard-dose infliximab
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