Infliximab induction regimens in steroid refractory acute severe colitis: a multi-centre retrospective cohort study with propensity score analysis

Sebastian, S.; Myers, S.; Argyriou, K.; Martin, G.; Los, L.; Fiske, J.; Ranjan, R.; Cooper, B.; Goodoory, V.; Ching, H.L.; Jayasooriya, N.; Brooks, J.; Dhar, A.; Shenoy, A.H.; Limdi, J.K.; Butterworth, J.; Allen, P.B.; Samuel, S.; Moran, G.W.; Shenderey, R.; Parkes, G.; Lobo, A.; Kennedy, N.A.; Subramanian, S.; Raine, T.

Abstract

Background:
Accelerated induction regimens of infliximab have been proposed to improve response rates in patients with steroid refractory acute severe colitis.

Aims:
We aimed to determine 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, 90 days and 12 months. We used propensity score analysis with optimal calliper matching using a priori defined high-risk covariates to reduce potential provider selection bias.

Results:
We included 131 patients receiving infliximab rescue therapy; 102 patients received standard induction and 29 received accelerated induction. In the unmatched cohort, there was no difference by type of induction in 30-day colectomy rates (18% vs. 20%, p=0.45), colectomy during index admission (13% vs. 20%, p = 0.26) or overall colectomy (20% vs. 24%, p= 0.38).

In the propensity score-matched cohort of 52 patients, 30-day colectomy (57% vs. 27%, p = 0.048) and index admission colectomy (53% vs. 23%,p =0.045) rates were higher in those receiving standard induction compared to accelerated induction but there was no difference in overall colectomy rates between the 2 groups (57% vs. 31%, p =0.09). 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 accelerated induction regimen.

Citation

Sebastian, S., Myers, S., Argyriou, K., Martin, G., Los, L., Fiske, J., …Raine, T. (2019). Infliximab induction regimens in steroid refractory acute severe colitis: a multi-centre retrospective cohort study with propensity score analysis. Alimentary Pharmacology and Therapeutics, 50(6), 675-683. https://doi.org/10.1111/apt.15456

• Journal Article Type: Article
• Acceptance Date: Jul 19, 2019
• Online Publication Date: Aug 27, 2019
• Publication Date: 2019-09
• Deposit Date: Aug 1, 2019
• Publicly Available Date: Aug 28, 2020
• Journal: Alimentary Pharmacology and Therapeutics
• Print ISSN: 0269-2813
• Electronic ISSN: 1365-2036
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 50
• Issue: 6
• Pages: 675-683
• DOI: https://doi.org/10.1111/apt.15456
• Keywords: Acute severe colitis, Rescue therapy, Accelerated induction, Standard Induction, Colectomy
• Public URL: https://nottingham-repository.worktribe.com/output/2368736
• Publisher URL: https://onlinelibrary.wiley.com/doi/full/10.1111/apt.15456
• Additional Information: This is the peer reviewed version of the following article: Sebastian, S, Myers, S, Argyriou, K, et al. Infliximab induction regimens in steroid‐refractory acute severe colitis: a multicentre retrospective cohort study with propensity score analysis. Aliment Pharmacol Ther. 2019; 50: 675– 683, which has been published in final form at https://doi.org/10.1111/apt.15456. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.