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Meta-Analysis
. 2019 Feb;17(3):502-509.e1.
doi: 10.1016/j.cgh.2018.06.031. Epub 2018 Jun 23.

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

Niharika Nalagatla  1 , Katherine Falloon  2 , Gloria Tran  3 , Nienke Z Borren  1 , Danny Avalos  4 , Jay Luther  1 , Francis Colizzo  1 , John Garber  1 , Hamed Khalili  1 , Joanna Melia  2 , Matthew Bohm  3 , Ashwin N Ananthakrishnan  5
Affiliations
Meta-Analysis

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

Niharika Nalagatla et al. Clin Gastroenterol Hepatol. 2019 Feb.

Abstract

Background & aims: In patients with acute severe ulcerative colitis (ASUC), standard infliximab induction therapy has modest efficacy. There are limited data on the short-term or long-term efficacy of accelerated infliximab induction therapy for these patients.

Methods: In a retrospective study, we collected data from 213 patients with steroid refractory ASUC who received infliximab rescue therapy at 3 centers, from 2005 through 2017. Patients were classified that received standard therapy (5mg/kg infliximab at weeks 0, 2, and 6) or accelerated therapy (>5mg/kg infliximab at shorter intervals). The primary outcome was colectomy in-hospital and at 3, 6, 12, and 24 months. Multivariable regression models were adjusted for relevant confounders. We also performed a meta-analysis of published effects of standard vs accelerated infliximab treatment of ASUC.

Results: In the retrospective analysis, 81 patients received accelerated infliximab therapy and 132 received standard infliximab therapy. There were no differences in characteristics between the groups, including levels of C-reactive protein or albumin. Similar proportions of patients in each group underwent in-hospital colectomy (9% receiving accelerated therapy vs 8% receiving standard therapy; adjusted odds ratio, 1.35; 95% CI, 0.38-4.82). There was no significant difference between groups in proportions that underwent colectomy at 3, 6, 12, or 24 months (P > .20 for all comparisons). Among those in the accelerated group, an initial dose of 10 mg/kg was associated with a lower rate of colectomy compared to patients who initially received 5 mg/kg followed by subsequent doses of 5mg/kg or higher. Our systematic review identified 7 studies (181 patients receiving accelerated infliximab and 436 receiving standard infliximab) and found no significant differences in short- or long-term outcomes.

Conclusion: 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.

Keywords: Acute Severe Ulcerative Colitis; Colectomy; Hospitalization; IBD Treatment; Infliximab; Multicenter; Patient Management; Surgery; TNF Antagonist.

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Conflict of interest statement

Conflicts of Interest: Ananthakrishnan has served on scientific advisory boards for Abbvie, Takeda, Gilead, and Merck and has received research support from Pfizer. The other authors have no conflicts to declare.

Figures

Figure 1:
Figure 1:
Rates of colectomy in-hospital, at 3, 12, and 24 months following hospitalization for acute severe ulcerative colitis and infliximab rescue therapy
Figure 2:
Figure 2:
Forest Plot of random effects meta-analysis of rate of in-hospital colectomy with standard and accelerated infliximab induction for acute severe ulcerative colitis
See this image and copyright information in PMC

Comment in

  • Effect of Accelerated Infliximab Induction on Outcomes of Acute Severe Ulcerative Colitis.
    Dai C, Jiang M, Huang YH. Dai C, et al. Clin Gastroenterol Hepatol. 2019 Aug;17(9):1918-1919. doi: 10.1016/j.cgh.2019.03.034. Epub 2019 Mar 27. Clin Gastroenterol Hepatol. 2019. PMID: 30928451 No abstract available.
  • Reply.
    Ananthakrishnan AN. Ananthakrishnan AN. Clin Gastroenterol Hepatol. 2019 Aug;17(9):1919. doi: 10.1016/j.cgh.2019.04.007. Epub 2019 Apr 6. Clin Gastroenterol Hepatol. 2019. PMID: 30965106 Free PMC article. No abstract available.

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