BACKGROUND Infliximab can prevent colectomy in patients hospitalized with acute severe ulcerative colitis (ASUC). In cases of ASUC, fecal losses of infliximab may lead to low drug levels and reduced efficacy. AIM To determine 90-day colectomy risk and postoperative complications in patients receiving single-dose and accelerated induction of infliximab for ASUC. METHODS We conducted a retrospective review of patients hospitalized with ASUC requiring infliximab therapy between 2013 and 2017 at the University of Michigan. Patients were excluded if they had an enteric infection, received an anti-TNF previously, or received cyclosporine during the same admission. The primary outcome was colectomy within 90 days of admission. Patients receiving single-dose induction infliximab were compared to those receiving accelerated rescue induction with two doses of infliximab prior to day 14. Administration of accelerated induction was guided by a protocol, suggesting administering a second dose of infliximab to those with only a partial response in CRP 3 days after the initial dose. Postoperative outcomes including 30-day readmission rates and complications were compared using descriptive statistics. RESULTS From 2013 to 2017, 66 patients with ASUC met our criteria. Thirty-three received accelerated induction (50.0%). The colectomy rate in the accelerated induction group was 30.3% versus 24.2% in the single-dose induction group (p = 0.58). There was no detected difference in postoperative outcomes between the accelerated and single-dose rescue induction. CONCLUSIONS In this retrospective review, 69.7% of those failing to respond to single-dose infliximab were able to avoid colectomy with an accelerated rescue induction strategy without worsening postoperative outcomes. Larger studies of accelerated dosing infliximab are needed.

中文翻译：

---

三级护理中心住院患者英夫利昔单抗的加速诱导策略在溃疡性结肠炎中的应用。

背景技术英夫利昔单抗可以预防急性重度溃疡性结肠炎（ASUC）住院患者的结肠切除术。在ASUC的情况下，英夫利昔单抗的粪便流失可能导致药物水平降低和疗效降低。目的确定接受单剂量和加速诱导英夫利昔单抗治疗ASUC的患者90天结肠切除术的风险和术后并发症。方法我们对密歇根大学于2013年至2017年间住院的需要英夫利昔单抗治疗的ASUC住院患者进行了回顾性研究。如果患者有肠感染，先前接受过抗TNF或在同一住院期间接受环孢素治疗，则将其排除在外。主要结局是入院后90天内进行结肠切除术。在第14天之前将接受单剂量诱导英夫利昔单抗的患者与接受两剂英夫利昔单抗的加速急救诱导的患者进行比较，根据方案指导进行加速诱导的给药，建议向仅部分缓解的患者给予第二剂英夫利昔单抗。初始剂量后3天进行CRP。使用描述性统计学比较包括30天再入院率和并发症在内的术后结果。结果2013年至2017年，66例ASUC患者符合我们的标准。有33人获得了加速入学的机会（50.0％）。加速诱导组的结肠切除率为30.3％，而单剂量诱导组的结肠切除率为24.2％（p = 0.58）。在加速和单剂量抢救诱导之间没有发现术后结果的差异。结论在本回顾性回顾中，对单剂量英夫利昔单抗无效的患者中有69.7％能够通过加速挽救策略避免结肠切除术，而不会恶化术后结果。需要更大剂量的英夫利昔单抗加速研究。