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Original research
Practice pattern variability in the management of acute severe colitis: a UK provider survey
  1. Shaji Sebastian1,2,
  2. Jessica Lisle3,
  3. Sreedhar Subramanian4,
  4. Anjan Dhar5,
  5. Achut Shenoy6,
  6. Jimmy Limdi7,
  7. Jeffrey Butterworth8,
  8. Patrick B Allen9,
  9. Sunil Samuel10,
  10. Gordon Moran10,11,
  11. Richard Shenderey12,
  12. Gareth Parkes13,
  13. Tim Raine14,
  14. Alan J Lobo15,
  15. Nicholas A Kennedy16
  1. 1 IBD Unit, Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK
  2. 2 Hull York Medical School, Hull, UK
  3. 3 Hull University Teaching Hospitals NHS Trust, Hull, UK
  4. 4 Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
  5. 5 Department of Gastroenterology, County Durham and Darlington NHS Foundation Trust, Bishop Auckland, UK
  6. 6 Department of Gastroenterology, Colchester Hospital University NHS Foundation Trust, Colchester, UK
  7. 7 Department of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester, UK
  8. 8 Department of Gastroenterology, Royal Shrewsbury Hospitals NHS Trust, Shrewsbury, UK
  9. 9 department of Gastroenterology, Ulster Hospital, Dundonald, UK
  10. 10 NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
  11. 11 Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK
  12. 12 Department of Gastroenterology, Airedale NHS Foundation Trust, Keighley, UK
  13. 13 Department of Gastroenterology, Royal London Hospital, London, UK
  14. 14 Department of Gastroenterology, Addenbrooke’s Hospital, Cambridge, UK
  15. 15 Gastroenterology Unit, Royal Hallamshire Hospital, Sheffield, UK
  16. 16 Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
  1. Correspondence to Professor Shaji Sebastian, IBD Unit, Hull Royal Infirmary, Hull HU3 2JZ, UK; Shaji.Sebastian{at}hey.nhs.uk

Abstract

Introduction Lack of comparative trial data on dosing regimens of infliximab in patients with acute severe ulcerative colitis (ASUC) failing intravenous corticosteroids has resulted in variability of rescue regimes in ASUC with potential impact on clinical outcomes. We aimed to evaluate practice variability and physician perspectives in decision-making with rescue therapy.

Methodology An internet-based survey of members of the inflammatory bowel disease (IBD) section of the British Society of Gastroenterology was conducted. The survey evaluated provider characteristics and general practice in the setting of ASUC, followed by a vignette with linked questions.

Results The response rate of the survey was 31% (209/682 IBD section members). 134 (78%) reported they would use standard infliximab dose (5 mg/kg) while 37 (22%) favoured a higher front-loading dose of 10 mg/kg citing low albumin, high C-reactive protein as their reason for their preference. IBD specialists chose the higher front-loading dose more often compared with other gastroenterologists (p=0.01) In the specific case vignette, accelerated induction (AI) was favoured by 51% of the respondents while 25% used the standard induction regime and 19% favoured colectomy. IBD specialists more often favoured AI compared with other gastroenterologists (p=0.03) with the main reason being presence of predictors of low infliximab levels (74%). The reasons cited for favouring standard induction (n=57) included lack of evidence for AI (18), their usual practice (11), unlicensed regime (7), and safety concerns (4).

Conclusions There are significant variations in practice in the use of infliximab rescue therapies with an urgent need for development of care pathways to standardise practice.

  • Acute severe colitis
  • Rescue therapy
  • Infliximab
  • Accelerated rescue
  • provider survey
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Footnotes

  • Contributors Shaji Sebastian, NAK and Sreedhar Subramanian- planned the study. JL, Shaji Sebastian and NAK developed the questionnaires. Shaji Sebastian, JL and NK analysed the data. SS and JL drafted the manuscript. AD, AS, PBA, JB, TR, RS, Shaji Sebastian, GP, GM and AJL contributed to data collection, reviewed and edited the manuscript. All authors reviewed and approved the final version of the manuscript. Shaji Sebastian is the guarantor of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No additional data are available.

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