Shail M Govani1,2,3, Jeffrey A Berinstein4, Akbar K Waljee4,5, Ryan W Stidham4, Peter D R Higgins4, Karin M Hardiman6. 1. South Texas Veterans Healthcare System, San Antonio, TX, 78229, USA. Shailgovani@gmail.com. 2. Department of Internal Medicine, UT Health San Antonio, San Antonio, TX, 78229, USA. Shailgovani@gmail.com. 3. Ohio Gastroenterology Group, 3400 Olentangy River Road, Columbus, OH, 43202, USA. Shailgovani@gmail.com. 4. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA. 5. Center for Clinical Management Research, Ann Arbor, MI, 48105, USA. 6. Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, 35233, USA.
Abstract
BACKGROUND: Infliximab can prevent colectomy in patients hospitalized with acute severe ulcerative colitis (ASUC). In cases of ASUC, fecal losses of infliximab may lead to low drug levels and reduced efficacy. AIM: To determine 90-day colectomy risk and postoperative complications in patients receiving single-dose and accelerated induction of infliximab for ASUC. METHODS: We conducted a retrospective review of patients hospitalized with ASUC requiring infliximab therapy between 2013 and 2017 at the University of Michigan. Patients were excluded if they had an enteric infection, received an anti-TNF previously, or received cyclosporine during the same admission. The primary outcome was colectomy within 90 days of admission. Patients receiving single-dose induction infliximab were compared to those receiving accelerated rescue induction with two doses of infliximab prior to day 14. Administration of accelerated induction was guided by a protocol, suggesting administering a second dose of infliximab to those with only a partial response in CRP 3 days after the initial dose. Postoperative outcomes including 30-day readmission rates and complications were compared using descriptive statistics. RESULTS: From 2013 to 2017, 66 patients with ASUC met our criteria. Thirty-three received accelerated induction (50.0%). The colectomy rate in the accelerated induction group was 30.3% versus 24.2% in the single-dose induction group (p = 0.58). There was no detected difference in postoperative outcomes between the accelerated and single-dose rescue induction. CONCLUSIONS: In this retrospective review, 69.7% of those failing to respond to single-dose infliximab were able to avoid colectomy with an accelerated rescue induction strategy without worsening postoperative outcomes. Larger studies of accelerated dosing infliximab are needed.
BACKGROUND: Infliximab can prevent colectomy in patients hospitalized with acute severe ulcerative colitis (ASUC). In cases of ASUC, fecal losses of infliximab may lead to low drug levels and reduced efficacy. AIM: To determine 90-day colectomy risk and postoperative complications in patients receiving single-dose and accelerated induction of infliximab for ASUC. METHODS: We conducted a retrospective review of patients hospitalized with ASUC requiring infliximab therapy between 2013 and 2017 at the University of Michigan. Patients were excluded if they had an enteric infection, received an anti-TNF previously, or received cyclosporine during the same admission. The primary outcome was colectomy within 90 days of admission. Patients receiving single-dose induction infliximab were compared to those receiving accelerated rescue induction with two doses of infliximab prior to day 14. Administration of accelerated induction was guided by a protocol, suggesting administering a second dose of infliximab to those with only a partial response in CRP 3 days after the initial dose. Postoperative outcomes including 30-day readmission rates and complications were compared using descriptive statistics. RESULTS: From 2013 to 2017, 66 patients with ASUC met our criteria. Thirty-three received accelerated induction (50.0%). The colectomy rate in the accelerated induction group was 30.3% versus 24.2% in the single-dose induction group (p = 0.58). There was no detected difference in postoperative outcomes between the accelerated and single-dose rescue induction. CONCLUSIONS: In this retrospective review, 69.7% of those failing to respond to single-dose infliximab were able to avoid colectomy with an accelerated rescue induction strategy without worsening postoperative outcomes. Larger studies of accelerated dosing infliximab are needed.
Authors: Jeffrey A Berinstein; Jessica L Sheehan; Michael Dias; Elliot M Berinstein; Calen A Steiner; Laura A Johnson; Randolph E Regal; John I Allen; Kelly C Cushing; Ryan W Stidham; Shrinivas Bishu; Jami A R Kinnucan; Shirley A Cohen-Mekelburg; Akbar K Waljee; Peter D R Higgins Journal: Clin Gastroenterol Hepatol Date: 2021-05-25 Impact factor: 11.382