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

Che Yung Chao, Alex Al Khoury, Achuthan Aruljothy, Sophie Restellini, Jonathan Wyse, Waqqas Afif, Alain Bitton, P. Lakatos, Talat Bessissow

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)518-523
Number of pages6
JournalDigestive Diseases and Sciences
Volume64
Issue number2
DOIs
Publication statusPublished - Feb 15 2019

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Colectomy
Ulcerative Colitis
Survival
Therapeutics
Infliximab
Albumins
Steroids
Regression Analysis

Keywords

  • Colectomy
  • Infliximab
  • Rescue therapy
  • Ulcerative colitis

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

High-Dose Infliximab Rescue Therapy for Hospitalized Acute Severe Ulcerative Colitis Does Not Improve Colectomy-Free Survival. / Chao, Che Yung; Al Khoury, Alex; Aruljothy, Achuthan; Restellini, Sophie; Wyse, Jonathan; Afif, Waqqas; Bitton, Alain; Lakatos, P.; Bessissow, Talat.

In: Digestive Diseases and Sciences, Vol. 64, No. 2, 15.02.2019, p. 518-523.

Research output: Contribution to journalArticle

Chao, Che Yung ; Al Khoury, Alex ; Aruljothy, Achuthan ; Restellini, Sophie ; Wyse, Jonathan ; Afif, Waqqas ; Bitton, Alain ; Lakatos, P. ; Bessissow, Talat. / High-Dose Infliximab Rescue Therapy for Hospitalized Acute Severe Ulcerative Colitis Does Not Improve Colectomy-Free Survival. In: Digestive Diseases and Sciences. 2019 ; Vol. 64, No. 2. pp. 518-523.
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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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T1 - High-Dose Infliximab Rescue Therapy for Hospitalized Acute Severe Ulcerative Colitis Does Not Improve Colectomy-Free Survival

AU - Chao, Che Yung

AU - Al Khoury, Alex

AU - Aruljothy, Achuthan

AU - Restellini, Sophie

AU - Wyse, Jonathan

AU - Afif, Waqqas

AU - Bitton, Alain

AU - Lakatos, P.

AU - Bessissow, Talat

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N2 - 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.

AB - 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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KW - Infliximab

KW - Rescue therapy

KW - Ulcerative colitis

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