Systematic Review: Efficacy and Safety of Accelerated Induction Regimes in Infliximab Rescue Therapy for Hospitalized Patients with Acute Severe Colitis
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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.
KeywordsAcute severe UC Rescue therapy Infliximab Accelerated induction
Acute severe ulcerative colitis
- TNF α
Tumor necrosis factor alpha
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.
As this is a systematic review no patient consent or ethical committee approval was sought.
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