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Use of Accelerated Induction Strategy of Infliximab for Ulcerative Colitis in Hospitalized Patients at a Tertiary Care Center

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Abstract

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.

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Funding

This work was supported by American Surgical Association Foundation Fellowship (5P50CA130810 and 5P30A046592 to KMH); John S. and Suzanne C. Munn Cancer Research Fund (KMH); and National Cancer Institute (K08CA190645 to KMH).

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Author notes

  1. Shail M. Govani and Jeffrey A. Berinstein have contributed equally to this manuscript.

Authors and Affiliations

  1. South Texas Veterans Healthcare System, San Antonio, TX, 78229, USA

    Shail M. Govani

  2. Department of Internal Medicine, UT Health San Antonio, San Antonio, TX, 78229, USA

    Shail M. Govani

  3. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA

    Jeffrey A. Berinstein, Akbar K. Waljee, Ryan W. Stidham & Peter D. R. Higgins

  4. Center for Clinical Management Research, Ann Arbor, MI, 48105, USA

    Akbar K. Waljee

  5. Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, 35233, USA

    Karin M. Hardiman

  6. Ohio Gastroenterology Group, 3400 Olentangy River Road, Columbus, OH, 43202, USA

    Shail M. Govani

Authors
  1. Shail M. Govani
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  2. Jeffrey A. Berinstein
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  3. Akbar K. Waljee
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  4. Ryan W. Stidham
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  5. Peter D. R. Higgins
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Contributions

Shail M. Govani was involved in conception, data collection/analysis, drafting article, and final approval. Jeffrey A. Berinstein was involved in data collection/analysis, drafting article, critical review of the manuscript, and final approval. Akbar K. Waljee was involved in conception, data analysis, critical review of the manuscript, and final approval. Ryan Stidham was involved in conception, critical review of the manuscript, and final approval. Peter D.R. Higgins was involved in conception, critical review of the manuscript, and final approval. Karin M. Hardiman was involved in conception, critical review of the manuscript, and final approval.

Corresponding author

Correspondence to Shail M. Govani.

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Conflict of interest

Dr. Ryan Stidham serves as a consultant to AbbVie. Dr. Peter Higgins serves as a consultant to AbbVie and Lycera. The authors have no other financial disclosures related to this manuscript.

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Govani, S.M., Berinstein, J.A., Waljee, A.K. et al. Use of Accelerated Induction Strategy of Infliximab for Ulcerative Colitis in Hospitalized Patients at a Tertiary Care Center. Dig Dis Sci 65, 1800–1805 (2020). https://doi.org/10.1007/s10620-019-05957-0

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  • DOI: https://doi.org/10.1007/s10620-019-05957-0

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