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Infliximab induction regimens in steroid‐refractory acute severe colitis: a multicentre retrospective cohort study with propensity score analysis
Author(s) -
Sebastian Shaji,
Myers Sally,
Argyriou Konstantinos,
Martin Gayle,
Los Louis,
Fiske Joseph,
Ranjan Ravi,
Cooper Benjamin,
Goodoory Vivek,
Ching HeyLong,
Jayasooriya NishaniLalanthika,
Brooks Johanne,
Dhar Anjan,
Shenoy Achut H.,
Limdi Jimmy K.,
Butterworth Jeffrey,
Allen Patrick B.,
Samuel Sunil,
Moran Gordon W.,
Shenderey Richard,
Parkes Gareth,
Lobo Alan,
Kennedy Nicholas A.,
Subramanian Sreedar,
Raine Tim
Publication year - 2019
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.15456
Subject(s) - medicine , colectomy , propensity score matching , infliximab , ulcerative colitis , cohort , retrospective cohort study , surgery , thiopurine methyltransferase , gastroenterology , inflammatory bowel disease , disease
Summary Background Accelerated induction regimens of infliximab have been proposed to improve response rates in patients with steroid‐refractory acute severe colitis. Aim To determine the differences in outcome for acute severe ulcerative colitis between accelerated and standard‐dose infliximab Methods We collected data on hospitalised patients receiving differing regimens of rescue therapy for steroid‐refractory acute severe ulcerative colitis. Our primary outcome was 30‐day colectomy rate. Secondary outcomes were colectomy within index admission, and at 90 days and 12 months. We used propensity score analysis with optimal calliper matching using high risk covariates defined a priori to reduce potential provider selection bias. Results We included 131 patients receiving infliximab rescue therapy; 102 received standard induction and 29 received accelerated induction. In the unmatched cohort, there was no difference by type of induction in the 30‐day colectomy rates (18% vs 20%, P = .45), colectomy during index admission (13% vs 20%, P = .26) or overall colectomy (20% vs 24%, P = .38). In the propensity score‐matched cohort of 52 patients, 30‐day colectomy (57% vs 27%, P = .048) and index admission colectomy (53% vs 23%, P = .045) rates were higher in those receiving standard induction compared to accelerated induction but there was no difference in overall colectomy rates (57% vs 31%, P = .09). There was no significant difference in length of stay or in complication and infection rates. Conclusion In a propensity score‐matched cohort, steroid‐refractory acute severe ulcerative colitis patients, short‐term, but not long‐term, colectomy rates appear to be lower in those receiving an accelerated induction regimen.