Comparison of medium to long- term outcomes of acute severe ulcerative colitis patients receiving accelerated and standard infliximab induction

Accelerated dose infliximab (IFX) induction is associated with a reduced short-term colectomy rate in acute severe ulcerative colitis (ASUC). In this issue Gibson et al report the medium and long term outcome – 145 patients, four centres, comparing standard (0, 2, 6 weeks) with accelerated dose (3 doses by 4 weeks) induction (See page 441) . In the participating centres Accelerated Dose induction (AD) has been used since 2014. Standard dose induction (SD) was classified by time, SD1 before and SD2 after 2014. Disease severity at induction was comparable in SD1 and AD groups but less in SD2. Time to colectomy was prolonged in AD and SD2 compared with SD1 – see figure two. In a Cox regression analysis factors independently associated with increased risk of colectomy included an endoscopic Mayo score of 3 at induction (HR 2.2 (95% CI 1.13 to 4.28), p=0.021) and increased CRP:ALB ratio at induction (HR 1.17 (95% CI 1.04 to 1.32), p=0.011). Conversely, use of an accelerated IFX induction regime was the only protective factor (HR 0.68 (95% CI 0.47 to 0.97), p=0.038). In summary therefore since 2014 with stratified use of IFX, AD induction in the more severe patients, outcome is improved. This data further supports the use …