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

Background and ObjectiveOptimization 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.MethodsHospitalized adult patients who received IFX for ASUC between 2010 and 2016 were identified. We compared standard inductions (5mg/kg) vs high-dose induction (10mg/kg) with 3-month colectomy rate as primary outcome.ResultsSeventy-two patients (62.5% male, median age 38.5) were identified. Thirty-seven patients (51.3%) received 5mg/kg IFX and 35 received 10mg/kg. Baseline clinical, biochemical and endoscopic parameters were well matched between these two groups. 10mg/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). CRP60 (OR 10.9 [95% CI 1.23-96.50], p=0.032), hemoglobin90g/L (OR 15.6 [95% CI 2.61-92.66], p=0.036) and albumin<30g/L (OR 9.4 [95% CI 1.06-83.13], p=0.044) were associated with increased risk of colectomy at 3months in univariate regression analysis.ConclusionUse 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.