INTRODUCTION Cyclosporine or infliximab (IFX) have been used to avoid surgery in patients with severe refractory ulcerative colitis (UC). Tacrolimus (Tac) is occasionally used as an alternative to cyclosporine; however, the comparative efficacy of Tac and IFX has not been reported. We aimed to compare the effectiveness of Tac and IFX in hospitalized UC patients. METHODS In a propensity score (PS)-matched cohort derived from a large nationwide database, 4-year effectiveness was compared between patients initiated on Tac or IFX. The primary outcome was the colectomy rate during the index hospitalization. We also analyzed the cumulative medication discontinuation, UC-related re-hospitalization, and colectomy rates after discharge. RESULTS Among 29,239 hospitalized patients, 4,565 were extracted for eligibility, of whom 2,170 were treated with Tac and the remaining 2,395 with IFX. After PS matching, 1,787 patients were selected for each group. During the index hospitalization, excluding patients who switched to another molecular-targeted agent, the colectomy rate was higher in the Tac group than the IFX group (7.8% vs 4.2%, P <0.01). Among patients discharged without colectomy, the cumulative medication discontinuation (28.4% vs 17.1%, P <0.01) and re-hospitalization (22.4% vs 15.4%, P <0.01) rates were higher in the Tac group than the IFX group; however, there was no difference in the cumulative colectomy rate (3.3% vs 2.7%). CONCLUSIONS Although Tac and IFX were effective for avoiding surgery in hospitalized UC patients, IFX was more effective than Tac. IFX also had higher long-term effectiveness. Future prospective studies comparing the efficacy of Tac and IFX is warranted.

中文翻译：

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他克莫司和英夫利昔单抗对溃疡性结肠炎住院患者的疗效比较。

简介 环孢素或英夫利昔单抗 (IFX) 已用于避免严重难治性溃疡性结肠炎 (UC) 患者的手术。他克莫司 (Tac) 偶尔用作环孢素的替代品；然而，Tac 和 IFX 的疗效比较尚未见报道。我们的目的是比较 Tac 和 IFX 对住院 UC 患者的疗效。方法 在来自大型全国数据库的倾向评分 (PS) 匹配队列中，比较了开始使用 Tac 或 IFX 的患者的 4 年疗效。主要结果是住院期间的结肠切除率。我们还分析了累计停药率、UC 相关的再住院率以及出院后的结肠切除率。结果 在 29,239 名住院患者中，提取了 4,565 名符合资格的患者，其中 2,170 名接受 Tac 治疗，其余 2,395 名接受 IFX 治疗。经过 PS 匹配后，每组共选择 1,787 名患者。在首次住院期间，排除换用另一种分子靶向药物的患者，Tac 组的结肠切除率高于 IFX 组（7.8% vs 4.2%，P <0.01）。在未进行结肠切除术的出院患者中，Tac 组的累计停药率（28.4% vs 17.1%，P <0.01）和再住院率（22.4% vs 15.4%，P <0.01）高于 IFX 组；然而，累积结肠切除率没有差异（3.3% vs 2.7%）。结论 虽然 Tac 和 IFX 对于避免住院 UC 患者进行手术是有效的，但 IFX 比 Tac 更有效。IFX 还具有较高的长期有效性。未来有必要进行比较 Tac 和 IFX 功效的前瞻性研究。