Infliximab Induction Regimens in Steroid-Refractory Acute Severe Colitis

A Multicentre Retrospective Cohort Study With Propensity Score Analysis

Shaji Sebastian; Sally Myers; Konstantinos Argyriou; Gayle Martin; Louis Los; Joseph Fiske; Ravi Ranjan; Benjamin Cooper; Vivek Goodoory; Hey-Long Ching; NishaniLalanthika Jayasooriya; Johanne Brooks; Anjan Dhar; Achut H. Shenoy; Jimmy K. Limdi; Jeffrey Butterworth; Patrick B. Allen; Sunil Samuel; Gordon W. Moran; Richard Shenderey; Gareth Parkes; Alan Lobo; Nicholas A. Kennedy; Sreedar Subramanian; Tim Raine

Disclosures

Aliment Pharmacol Ther. 2019;50(6):330-335. 

In This Article

Results

Study Cohort

We included data on 131 patients from 11 centres across the UK receiving rescue therapy for steroid-refractory ASUC, of which 102 received standard induction regime and 29 received accelerated induction regimen. The baseline characteristics are recorded in Table 1. There were differences in blood parameters between the patients receiving standard induction and accelerated induction rescue (Table 2). Patients receiving accelerated regimen were more likely to have higher CRP levels, higher CRP/albumin ratio and lower albumin levels at day 1 and day 3 and there were no differences between the two groups in terms of haemoglobin on day 1 or day 3.

Colectomy Rates: Entire Cohort

The overall colectomy rate among the 131 patients who received rescue therapy was 29%. Table 3 reports the colectomy rates at 30 days, 90 days, 6 months and 12 months in patients receiving rescue therapy. There was no significant difference in overall colectomy rates between in-patients receiving standard induction vs accelerated induction group (P = .996) (Table 3 and Figure 1).

Figure 1.

Kaplan-Meier plot for colectomy-free survival—accelerated induction vs standard induction: unmatched cohort

Colectomy Rates: Propensity Score-matched Cohort

Using propensity score matching, we included 52 matched patients receiving rescue therapy for comparison. The baseline characteristics and blood markers in the cohort are detailed in Table 4.

In the propensity score-matched cohort, there was no difference in overall colectomy rates between standard induction and accelerated induction groups (57% vs 31%, P = .09), but the index admission colectomy (53% vs 23%, P = .045) and 30-day colectomy (57% vs 27%, P = .048) rates were higher in those receiving standard induction (Figure 2).

Figure 2.

Kaplan-Meier plot for colectomy-free survival—accelerated induction vs standard induction: matched cohort

Duration of Hospital Stay and Complications

The mean duration of hospital stay in patients treated with standard induction was 4.4 days (SD 1.6) less than patients given accelerated induction rescue therapy (P < .01) in the unmatched cohort. In the propensity score-matched cohort, there was no significant difference in the length of stay between standard induction and accelerated induction groups (23.6 ± 4.3 vs 19.2 ± 7.1 days, P = .09). There was no difference in complication rates between the two groups (18.6% vs 20.7%, P = .8) but there was one death in the accelerated induction group (Table 5).

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