Systematic Review: Efficacy and Safety of Accelerated Induction Regimes in Infliximab Rescue Therapy for Hospitalized Patients with Acute Severe Colitis

  • S. SebastianEmail author
  • S. Myers
  • S. Nadir
  • S. Subramanian



Pharmacokinetic data suggest that standard induction dosing schedules may not be sufficient in patients with acute severe colitis (ASUC). Hence, intensified induction regimes are increasingly used in the rescue treatment of hospitalized patients with ASUC to avoid the need for colectomy although the evidence for this is uncertain.


To conduct a systematic review of short- and long-term efficacy outcomes from accelerated infliximab induction studies.


Systematic search of relevant databases (MEDLINE, EMBASE, Cochrane Database of Systematic Reviews) and relevant conference proceedings (Digestive Diseases Week, European Colitis and Crohn’s Organisation Congress, United European Gastroenterology Week) was done.


We identified ten relevant studies with a total of 705 patients, of whom 308 received an intensified infliximab regime. Pooled analysis showed no difference in short-term or long-term colectomy rates in those receiving accelerated induction regimes when compared to standard induction. No significant differences in complication rates were identified.


The available uncontrolled studies so far do not suggest short-term or long-term benefit in using accelerated induction in hospitalized ASUC. The overall poor quality of available studies with confounding variables indicates the need for a randomized controlled trial with personalized risk stratification.


Acute severe UC Rescue therapy Infliximab Accelerated induction 



Ulcerative colitis


Acute severe ulcerative colitis


Accelerated induction


Standard induction


Tumor necrosis factor alpha


Author’s contribution

SS, SM, and SN designed study concept and did searches and analysis. SS, SM, and SN drafted the manuscript.

Compliance with ethical standards

Conflict of interest

Shaji Sebastian holds research grants from Takeda, AbbVie, Warner Chilcott, Ferring, MSD, serves on the advisory boards of Takeda, AbbVie, Merck, Ferring, Pharmacocosmos, Warner Chilcott, Janssen, Falk Pharma, Biohit, TriGenix, Cellgene, and Tillots Pharma, and has received speaker fees from Abbvie, Jaansen, Merck, Warner Chilcott, and Falk Pharma. Sree Subramanian has received speaker fee from MSD, Actavis, Abbvie, Takeda, Dr Falk pharmaceuticals, and Shire and received educational grant from MSD, Abbvie, and Actavis and is an advisory board member for Abbvie, Dr Falk pharmaceutics, and Vifor pharmaceuticals. Sally Myers and Syed Nadir have no conflicts to declare.

Ethical approval

As this is a systematic review no patient consent or ethical committee approval was sought.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.IBD UnitHull and East Yorkshire NHS TrustHullUK
  2. 2.Hull York Medical SchoolHullUK
  3. 3.The Royal Liverpool and Broad Green University Hospitals NHS Foundation TrustLiverpoolUK

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