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Have changing practices in salvage medical options affected colectomy rates in acute severe ulcerative colitis?

Intern Med J. 2023 Mar 14. doi: 10.1111/imj.16074. Online ahead of print.


BACKGROUND: In 2014, infliximab (IFX) was listed on the Australian Pharmaceutical Benefits Scheme for acute severe ulcerative colitis (ASUC) and is now the preferred option for medical salvage, superseding cyclosporin (CsA). Optimal dosing schedules for IFX remain unknown.

AIM: We aim to evaluate the effect of changing from predominantly CsA to almost exclusively IFX for the treatment of steroid refractory ASUC on colectomy rates.

METHODS: A retrospective review was performed of patients admitted with ASUC between 2012-2020. Patients were categorised into two groups according to year of presentation – either “historical treatment” cohort (2012-2014), when CsA was primarily used, or “contemporary treatment” cohort (2014-2020) when IFX was mostly prescribed, in either standard or intensive doses.

RESULTS: 139 patients were included; 37 in the historical treatment cohort and 102 in the contemporary treatment cohort. In the historical treatment cohort, 12/37 received salvage therapy, 8 (67%) with CsA. In the contemporary treatment cohort, 49/102 patents received salvage therapy, 40 (82%) with IFX, of whom 22 (53%) received intensified doses. Colectomy rates were similar at 30 days, 6 months and 12 months between historical and contemporary treatment cohorts (14% vs 12%, p = 0.77, 19% vs 18%, p >0.99; and 22% vs 18%, p = 0.63 respectively). Difference in 12-month colectomy rates between standard vs intensive IFX did not meet statistical significance (3/21 (14%) vs 9/22 (41%), respectively; p = 0.09).

CONCLUSION: There was no difference in 30-day, 6-month or 12-month colectomy rate between the historical treatment and contemporary treatment cohorts. The use of IFX, rather than CsA, even at intensified dosing has not appeared to reduce the colectomy rate observed in our patients. This article is protected by copyright. All rights reserved.

PMID:36916208 | DOI:10.1111/imj.16074

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