Che-Yung Chao1,2, Alex Al Khoury1, Achuthan Aruljothy1, Sophie Restellini1,3, Jonathan Wyse4, Waqqas Afif1, Alain Bitton1, Peter L Lakatos1,5, Talat Bessissow6. 1. Division of Gastroenterology, Montreal General Hospital, McGill University Health Centre, 1650 Avenue Cedar C7-200, Montreal, QC, H3G 1A4, Canada. 2. Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia. 3. Department of Gastroenterology and Hepatology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland. 4. Division of Gastroenterology, Jewish General Hospital, McGill University, Montreal, Canada. 5. Department of Gastroenterology, Semmelweis University, Budapest, Hungary. 6. Division of Gastroenterology, Montreal General Hospital, McGill University Health Centre, 1650 Avenue Cedar C7-200, Montreal, QC, H3G 1A4, Canada. talat.bessissow@mcgill.ca.
Abstract
BACKGROUND AND OBJECTIVE: Optimization 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. METHODS: Hospitalized adult patients who received IFX for ASUC between 2010 and 2016 were identified. We compared standard inductions (5 mg/kg) vs high-dose induction (10 mg/kg) with 3-month colectomy rate as primary outcome. RESULTS: Seventy-two patients (62.5% male, median age 38.5) were identified. Thirty-seven patients (51.3%) received 5 mg/kg IFX and 35 received 10 mg/kg. Baseline clinical, biochemical and endoscopic parameters were well matched between these two groups. 10 mg/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). CRP ≥ 60 (OR 10.9 [95% CI 1.23-96.50], p = 0.032), hemoglobin ≤ 90 g/L (OR 15.6 [95% CI 2.61-92.66], p = 0.036) and albumin < 30 g/L (OR 9.4 [95% CI 1.06-83.13], p = 0.044) were associated with increased risk of colectomy at 3 months in univariate regression analysis. CONCLUSION: Use 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.
BACKGROUND AND OBJECTIVE: Optimization 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. METHODS: Hospitalized adult patients who received IFX for ASUC between 2010 and 2016 were identified. We compared standard inductions (5 mg/kg) vs high-dose induction (10 mg/kg) with 3-month colectomy rate as primary outcome. RESULTS: Seventy-two patients (62.5% male, median age 38.5) were identified. Thirty-seven patients (51.3%) received 5 mg/kg IFX and 35 received 10 mg/kg. Baseline clinical, biochemical and endoscopic parameters were well matched between these two groups. 10 mg/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). CRP ≥ 60 (OR 10.9 [95% CI 1.23-96.50], p = 0.032), hemoglobin ≤ 90 g/L (OR 15.6 [95% CI 2.61-92.66], p = 0.036) and albumin < 30 g/L (OR 9.4 [95% CI 1.06-83.13], p = 0.044) were associated with increased risk of colectomy at 3 months in univariate regression analysis. CONCLUSION: Use 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.
Authors: Mark S Silverberg; Jack Satsangi; Tariq Ahmad; Ian D R Arnott; Charles N Bernstein; Steven R Brant; Renzo Caprilli; Jean-Frédéric Colombel; Christoph Gasche; Karel Geboes; Derek P Jewell; Amir Karban; Edward V Loftus; A Salvador Peña; Robert H Riddell; David B Sachar; Stefan Schreiber; A Hillary Steinhart; Stephan R Targan; Severine Vermeire; B F Warren Journal: Can J Gastroenterol Date: 2005-09 Impact factor: 3.522
Authors: Maria Theresa Arias; Niels Vande Casteele; Séverine Vermeire; Anthony de Buck van Overstraeten; Thomas Billiet; Filip Baert; Albert Wolthuis; Gert Van Assche; Maja Noman; Ilse Hoffman; Andre D'Hoore; Ann Gils; Paul Rutgeerts; Marc Ferrante Journal: Clin Gastroenterol Hepatol Date: 2014-08-10 Impact factor: 11.382
Authors: Shailja C Shah; Steven Naymagon; Hinaben J Panchal; Bruce E Sands; Benjamin L Cohen; Marla C Dubinsky Journal: Inflamm Bowel Dis Date: 2018-02-15 Impact factor: 5.325
Authors: Shanika de Silva; Christopher Ma; Marie-Claude Proulx; Marcelo Crespin; Belle S Kaplan; James Hubbard; Martin Prusinkiewicz; Andrew Fong; Remo Panaccione; Subrata Ghosh; Paul L Beck; Anthony Maclean; Donald Buie; Gilaad G Kaplan Journal: Clin Gastroenterol Hepatol Date: 2011-07-30 Impact factor: 11.382
Authors: Gunnar Järnerot; Erik Hertervig; Ingalill Friis-Liby; Lars Blomquist; Per Karlén; Christer Grännö; Mogens Vilien; Magnus Ström; Ake Danielsson; Hans Verbaan; Per M Hellström; Anders Magnuson; Bengt Curman Journal: Gastroenterology Date: 2005-06 Impact factor: 22.682
Authors: K R Gardiner; M I Halliday; G R Barclay; L Milne; D Brown; S Stephens; R J Maxwell; B J Rowlands Journal: Gut Date: 1995-06 Impact factor: 23.059
Authors: Shaji Sebastian; Jessica Lisle; Sreedhar Subramanian; Anjan Dhar; Achut Shenoy; Jimmy Limdi; Jeffrey Butterworth; Patrick B Allen; Sunil Samuel; Gordon Moran; Richard Shenderey; Gareth Parkes; Tim Raine; Alan J Lobo; Nicholas A Kennedy Journal: Frontline Gastroenterol Date: 2019-08-17