In the Journals

Accelerated Remicade induction offers no improvement in colectomy rates

Using an accelerated induction therapy of Remicade for a rescue treatment of acute severe ulcerative colitis did not help improve colectomy rates compared with using a standard therapy, according to research published in Clinical Gastroenterology and Hepatology.

Although it has shown benefits for steroid refractory patients, Ashwin N. Ananthakrishnan, MD, MPH, of the division of gastroenterology at Massachusetts General Hospital, and colleagues wrote that many patients still fail to achieve response on standard Remicade (infliximab, Janssen) therapy.

“One-third of patients with [acute severe ulcerative colitis (ASUC)] fail to respond to intravenous steroid therapy and require either medical rescue therapy or colectomy,” they wrote. “Despite [infliximab] being efficacious in this setting, a significant proportion of patients with ASUC do not respond adequately to standard dosing.”

Ananthakrishnan and colleagues conducted a multicenter, retrospective cohort study to compare outcomes of standard vs. accelerated infliximab dosing in patients with ASUC, as well as a meta-analysis to find any short- or long-term benefits for accelerated dosing for the treatment of ASUC.

Investigators divided patients with refractory ASUC who received infliximab rescue therapy at one of three health care centers between 2005 and 2017 into two groups. The standard therapy group received 5 mg/kg at weeks 0, 2 and 6 (n = 132), and the accelerated therapy group received more than 5 mg/kg at shorter intervals (n = 81).

Researchers found that 9% of patients in the accelerated group and 8% of patients in the standard group underwent in-hospital colectomy (adjusted OR = 1.35; 95% CI, 0.38–4.82). There was also no significant difference between groups in the number of the patients who underwent colectomy at 3, 6, 12, or 24 months.

In the accelerated group, patients who received an initial dose of 10 mg/kg were associated with lower colectomy rates compared with patients who received an initial dose of 5 mg/kg and later received a higher dose.

The investigators’ systematic review and meta-analysis found no differences in short- or long-term outcomes when comparing accelerated with standard therapy.

“We did not find accelerated infliximab induction to be superior to standard induction in all patients with ASUC,” they wrote. “However, confounding by disease severity cannot be excluded, as the common practice at each center was to favor accelerated induction for those felt to have more severe disease. There is a need for prospective randomized clinical trials and larger multi-center prospective cohorts to better identify the optimal medical rescue strategy in patients with ASUC to reduce morbidity and improve patient outcomes.” – by Alex Young

Disclosures: Ananthakrishnan reports that he has served on scientific advisory boards for AbbVie, Takeda, Gilead and Merck, and he has received research support from Pfizer. Please see the full study for all other authors’ relevant financial disclosures.

Using an accelerated induction therapy of Remicade for a rescue treatment of acute severe ulcerative colitis did not help improve colectomy rates compared with using a standard therapy, according to research published in Clinical Gastroenterology and Hepatology.

Although it has shown benefits for steroid refractory patients, Ashwin N. Ananthakrishnan, MD, MPH, of the division of gastroenterology at Massachusetts General Hospital, and colleagues wrote that many patients still fail to achieve response on standard Remicade (infliximab, Janssen) therapy.

“One-third of patients with [acute severe ulcerative colitis (ASUC)] fail to respond to intravenous steroid therapy and require either medical rescue therapy or colectomy,” they wrote. “Despite [infliximab] being efficacious in this setting, a significant proportion of patients with ASUC do not respond adequately to standard dosing.”

Ananthakrishnan and colleagues conducted a multicenter, retrospective cohort study to compare outcomes of standard vs. accelerated infliximab dosing in patients with ASUC, as well as a meta-analysis to find any short- or long-term benefits for accelerated dosing for the treatment of ASUC.

Investigators divided patients with refractory ASUC who received infliximab rescue therapy at one of three health care centers between 2005 and 2017 into two groups. The standard therapy group received 5 mg/kg at weeks 0, 2 and 6 (n = 132), and the accelerated therapy group received more than 5 mg/kg at shorter intervals (n = 81).

Researchers found that 9% of patients in the accelerated group and 8% of patients in the standard group underwent in-hospital colectomy (adjusted OR = 1.35; 95% CI, 0.38–4.82). There was also no significant difference between groups in the number of the patients who underwent colectomy at 3, 6, 12, or 24 months.

In the accelerated group, patients who received an initial dose of 10 mg/kg were associated with lower colectomy rates compared with patients who received an initial dose of 5 mg/kg and later received a higher dose.

The investigators’ systematic review and meta-analysis found no differences in short- or long-term outcomes when comparing accelerated with standard therapy.

“We did not find accelerated infliximab induction to be superior to standard induction in all patients with ASUC,” they wrote. “However, confounding by disease severity cannot be excluded, as the common practice at each center was to favor accelerated induction for those felt to have more severe disease. There is a need for prospective randomized clinical trials and larger multi-center prospective cohorts to better identify the optimal medical rescue strategy in patients with ASUC to reduce morbidity and improve patient outcomes.” – by Alex Young

Disclosures: Ananthakrishnan reports that he has served on scientific advisory boards for AbbVie, Takeda, Gilead and Merck, and he has received research support from Pfizer. Please see the full study for all other authors’ relevant financial disclosures.

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