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

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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.

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Acknowledgments

The co-authors would like to thank Janie Coulombe for her kind assistance with the statistical analysis of the study data.

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Authors and Affiliations

  1. Division of Gastroenterology, Montreal General Hospital, McGill University Health Centre, 1650 Avenue Cedar C7-200, Montreal, QC, H3G 1A4, Canada

    Che-Yung Chao, Alex Al Khoury, Achuthan Aruljothy, Sophie Restellini, Waqqas Afif, Alain Bitton, Peter L. Lakatos & Talat Bessissow

  2. Division of Gastroenterology, Jewish General Hospital, McGill University, Montreal, Canada

    Jonathan Wyse

  3. Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia

    Che-Yung Chao

  4. Department of Gastroenterology, Semmelweis University, Budapest, Hungary

    Peter L. Lakatos

  5. Department of Gastroenterology and Hepatology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland

    Sophie Restellini

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  1. Che-Yung Chao
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  2. Alex Al Khoury
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  3. Achuthan Aruljothy
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Corresponding author

Correspondence to Talat Bessissow.

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None declared by all co-authors.

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Co-First Authors: Che-Yung Chao, Alex Al Khoury

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Chao, CY., Al Khoury, A., Aruljothy, A. et al. High-Dose Infliximab Rescue Therapy for Hospitalized Acute Severe Ulcerative Colitis Does Not Improve Colectomy-Free Survival. Dig Dis Sci 64, 518–523 (2019). https://doi.org/10.1007/s10620-018-5358-z

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  • DOI: https://doi.org/10.1007/s10620-018-5358-z

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